Permit I • A
C ITY OF TIGARD PLUMBING PERMIT
4 l4" DEVELOPMENT SERVICES PERMIT #: PLM2004 -00241
' � 1 1 � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/28/2004
SITE ADDRESS: 12370 SW THORNWOOD DR PARCEL: 2S1106C -06100
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 032 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Backflow preventer install.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST #100 [PLUMB] Permit Fee 5/28/2004 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 5/28/2004 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 - 692 - 5945 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: �- /' Permittee Signature: /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
May 27 04 1 1 : 1 la dan edmonds 503-692-0768 p . 2
1 .4 '' ' ' - ' •: • H. ' . f '' ' .FOR OFFICE USE .ONI.A.' .• ..- • :.' .-: .., ..-
- I-qum`bing PermiUtation . ' Received, ;,., v . p A Plumbing
is'Illala 1 / - Od ° 1 4 //
vkec- Date/By-9 d / 9 Vr.) Permit No.:
Planning - ppm . Sewer
City of Tigard
1.0 . Date/By: Permit No.:
13125 SW Hall Blvd. . t k t, 1) . .\( ;_, I Plan Review Other
Tigard, Oregon 97223 V" , cep Date/By:.
Post-Review , Permit No.:
Land Use
Internet www.citigard.o MG t" . ..ai i
Contact I f El See Page 2 for
24-hour Inspection Requ -639-4175 ''' • • Namattelbod: - I Supplemental Information.
• 7 : : • -......'.:.::; TYPE' WORK: : ' ' :-.: .. f. .• '■ FEE'c.r.scHEDuixtroe:iiiiiikirliifiritiatiOn:.04:11eddIttI ' ::•• :',
NNew construction • 0 Demolition Description 1 Qty. 1 Fee(ea.) Total
O Addition/alteration/replacement 0 Other: . ;:...;:•:..'L.;.::-..;.;•?•::•.,:i.•:••:',-,,NeNielt..1414:161111y;iiyiellinge f [I .-:.":!...; . :''...• . - • •-: :- ' • . •
;::...:Y••••-:: ::::.::` (ineliiii4
. • .,.: .. - ,' :' CATEGORY OF CONSTRUCTION:I.:. .:..:',-;.-....::. SFR (1) bath 24920
N, & 2-Family dwelling ID Commercial/Industrial - SFR (2) bath 350.00
- rjAccessory Building . 0 Multi-Family SFR (3) bath 399.00
O Master Builder - •• 0 Other. Each additional bath/kitchen 45.00
; : ' ..' • . ".: JOB SITE`INFORMA'TION•ind-LOCATION:.::':%' Fire sprinkler - sq. ft.: . Page 2
Job site address: i'37(.) Thi,YALI.:(.1 b7i ue.., •:':,,::;•.:: .sif*Utiliiiii,: .: • .: :‘, • r...r.::: • .
Suite #: I Bldg./Apt.#: Catch basia/area drain 16.60
Drywelllleach line/trench drain 16.60
Project Namerr U LOT 32- Footing drain (no. linear R.) Page 2 •
Cross street/Directions to job site: manufactured home utilities 110.00
kb() ISI, i / 11.- rk -) i/Z/0 Manholes
_ Rain drain connector 16.60
16.60
Sanitary sewer (no- linear ft.) Page 2
Subdivision:MO rryl Luc) ock 1 Lot #: 3 z.-- , Storm sewer (no. linear ft.) Page 2
Water service linear ft Page 2
Tax map/parcel #: Co SS' /3 5
. '':.::- ..••• •:•••• • ' .,..- - •
DESCRIPTION OF WORK
Absorption valve 16.60 '
Land Cap G. I/az-ie./IOW clef-) Ice) Baddiow preventer i Page 2 77- SS"
Backwater valve 16.60
-
Clothes washer 16.60
' Dishwasher 16.60
Drinking fountain 16.60
13.PROPERTYOV.VPIER•:...:' -1 ..:' .•:=:.:-'.-..":::-.:.:..::::-.:1.',.!:-.5:. Ejectors/sump -
. .
Name: DONI ,vVYYis.S_12.4 i-itn-nc-S - Expansion tank 16.60
- Address:4-A 30 ...TA/3 &e.)-62-1,-)00 a.? Fixture/sewer cap 16.60
Floor drain/floor sinldhub • 16.60
City/State/Zip:1,0-4 0-C-ti-e-56 q70-ag Garbage disposal 16.60
.
Phone: Fax: Hose bib 16.60
:ASLAPPLICANT ••••:. 2.:..: ..••••••:: :•••'..• '. '. laCONTA.CtPERSOPI.:' ?..: Ice maker 16.60
_ Name: ei Lc() Spo-r Intaceptor/grease trap 16.60
Address:! o 0 C.A.A3 illy.SICIA9 .12D Medical as - value: S . Page 2
City/State/Zip: - Tu_416.1 - tn... 0 R. .41-10(6a- . Primer
Roof drain (commercial) 16.60
16.60
PhoneSce Coca. - Si t/S I FaxS53 toga.- 076g Sink/basin/lavatory 16.60
E-mail: . Tub/shower/shower pan 16.60
:..::, ::::'....•.`: .-.:'.....,. -- KY.. :-. ::.CONTRACTOR :I - ....:.•:: :-.:*;.•::,':.::~i,...;=::.:::!..'.''':?.7.-.:S'.- Urinal 16.60
Business Name: 1..D-r4scape,_ 0 rciaN -r-rIc., water closet 16.60
.
Water heater 16.60
•
Address: 1?--00 SLA) rY114.Cimrj. ten. . - Other:
City/State/Zip:m- 'Pk- cnotoa- Other:
PhoneSie idia - sly s Fax)3 C6901 - Oglak . • . f .:•'"c2- ...: . • ' '
1 CCB Lic. #: - 7ebLi Plumb. Lic.#: Subtotal S
Minimum Permit Fee $72.50 S
Aulhorize , , _ __ 3 4, . as
4 Date: ep .Slailloti, Residential Backflow Minimum Fee S36.25
Signature. . Plan Review 25% of Permit Fee S
Eli ert ‘ cpar - ra7J3 State Surcharge (8% of Permit Fee) S .2 . _90
(Please print name) TOTAL PERMIT FEE S 39_ / 5
Notice: This permit application expires ifs permit is uot obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after It has been accepted as complete, riser diagram for plan review.
-. - *Fee methodology set by Tr-County Building Industry Service Board.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lioe: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested d 1C AM PM BUP
Location J, 37n .r9'LYL�L s Suite MEC
Contact Person Ph ( ) PLM c
Contractor Ciiete- Ph ( ) (0q,; " S�'�t SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
'T FAIL
•os & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower
Othertbi
Fin - :-
l ay PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
•
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA ( � j� (6r
Approach/Sidewalk Date 1 O Inspector \�- ' vl'i) Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL