Permit C ITY OF TIGARD PLUMBING PERMIT
AA DEVELOPMENT SERVICES PERMIT #: PLM2003 -00520
� �� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 12325 SW THORNWOOD DR PARCEL: 2S1106C -05000
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 021 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: Installation of residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 9/30/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 9/30/03 $2.90
Total $39.15
Phone : 503 387 - 3875
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 692 - 5945 RP /Backflow Preventer
Final Inspection
Reg #: PLM 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
Issu By: ,achUY''„ Permittee Signature: 4, !:/i►
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
il l°N.Q 3 03 02: 42p dan edmonds 5 0 3 - 6 9 2 - 0 7 6 8 P - 6
• FOR OFFICE USE ONLY • .• . • •
Plumbing Permit Application Received 0 ,,,,, Plumbing i
RECEIVED Da : : / .. Permit No.:
Planning Approval Sewer
Ci . _
ty of Tigard Date/By: . Permit No.:
.
13 125 SW Hall Blvd. SEP 2 9 2003 ..Alk,, Plan Review Other
Tigard, Oregon 97223 . Date/By: . _ Permit No.:
Phone: 5�3-639-4171 Fax: 503-598-1960 z „,..,,,,,,,„ ; r =•,, .
Post-Review
Internet 7; w.ciligard.orGhTY OF TIGARD I f 11"' ricili I -
1
_ Date/By: -
Contact • _ Land Use
Case No.: •
• .1.4.- I 14I See Page 2 for
24-hour ection Requils1111.1:014V39.121/11$0N , Name/Method: . _---ria. i Supplemental Information. ‘ '
. ':' : • , : - - - . ..- - i.I . ::1 - !-::f..!':• - -:...''..:" TYPE.OF '. - ::: • '• :':.i.t.::-.:4'.:.'•`::::.1:..-', .,1',-.:TEE.F..SCHEIDULEIfor.. special information 'iiieTchickliit) • . -
13New t onstruction • I 0 Demolition Description Qty. I Fee(ea.) I Total
0 Addi 'on/alteration/replacement I 0 Other: . ;-....-1....:•:.;,f.;-,..;.•:',";....-:. : ,dyiittings•• ; ': .' ::..' ..,-- ; •,. 1 : .f:,.. ..
...'"!;•-•:...-:;-••••."....:':i...::•.firieliiiieti.lonii'. iip'iiiiiitiiittniiitiiinediaiij.;.;
- • -. : - ... • ..,-- CATEGORY .CONSTRUCTIOli: ;.:‘.`:-.•:-.•••:.-!..:.•.'-•
bath
i I &t dwelling 0 Commercial/Industrial SFR (2) bath _ 3 24 5 9 0 ..2 00 0
DA.cc e ory Building . 0 Multi-Family SFR (3) bath . 399 . 00
Ell Master Builder • D Other:
Each additional bath/kitchen 45.00
• ,.:'.. ....'.013:SITE INFORMATION 'and LOCATION:. '..... - Fire sprinkler - sq. ft.: Page 2
Job site address: h2,3c....LT Sw n D u t__ . -,.:-:.-.'-:-.-!: .j.::' ..L . .Y.:'::::• 7: j.- ..7.: site utifiites:"...::." :,:.,-,: ., :.- •;:.:.:::_:;:::.,.:.::::•. .: . ::::., ....-.
,
Suite #: - 1 Bldg./Apt.#: Catch basin/area drain .- 16.60
Th
. Drywell/leach line/trench ft.) drain '16.60
Project *Tame: •ern L4-700Ct_ Lar 19
Footing drain (no. linear Page 2
Cross street/Directions to joksite: . Manufactured home utilities 110.00
SIA '611 it te-1 _ Manholes , 16.60 .
Rain drain connector 16.60
• Sanitary sewer (no. linear ft.1 Page 2 .
SubdiviionrillOY WO OC(... I Lot tai Storm sewer (no. linear ft.) Page 2
Tax ma parce1#: (.0 S. .5 a en
Iv Water service (no. linear ft.1 Page 2
: '
::: - C. :;•'•'..4.'..:•A :Fiitiire;nr ' -. --; -....: '':-.:....:::•;",:.,:-..•••
Absorption Valve _ 16.60
• -:" ..:, '.; f .: -.:'•::::-DESCRIPTIONOFWORK.,:-'.•;.:.:',!7,,,,..,,.,,.., :-(....?•;:,:- •
Lan/ cape, - giLeic - i - 10 14 ) c1:60 cce_) Backflow preventer i Page 2 a?.. sS
Backwater valve • 16.60
_
Clothes washer
- 16.60
Dishwasher
.
• . _
• Drinking_fountain • . 16.60
,
19..TROPERTY.OWNER :- •:';-:: -. 1:0 TENANT. E 16.60
i
Name: D m (TYI.S
J-41 I--,-_.s Expansion ntank 16.60
e
Addr s:4A 30 LC) -&A-C424.,-)00 ct.) Fixture/sewer cap 16.60
City/Ste/Zip: l,o-ie..-e._ 0w
4-e56 Q
a
Floor drain/floor sink/hub .
_
• Garbage disposal . 16.60
Phone: Fax: Hose bib _ 16,60
'tikAPPiICANT ' y•;.:;• • -::..';''. -;......,:.....::- SICONTACT..PERSOIV: - Ice maker _ 16.60
Name: el. 1 ell S.po-r-rol-t..) Interceptor/grease trap • 16.60
-
Address: I ...-43 0 - ri.:9-c-111A9 RD . - Medical gas - value: $ Page 2
- Primer 16.60
City/Sate/Zip: - RAP-tart ix._ 0 A. 910 to „
Roof drain (commercial) 16.60
Phone .-43 (4 - S 45 I Fax lo a.- 07/0 g ' Sink/basin/lavatory • 16.60 . I
E-mail: . Tub/shower/shower pan 16.60
..;:.; ,.....-...• ..:•p ZOINTRACTOR....-,'...:;.-;:-Q:.f7.=:;:::.:::.:::.i.;;;':;:i.:•:.r.:'_'`:- Urinal • 16.60
Busin Name: La_inctscapt 0 re_idyN -r_ _ _
e ( -00 SAA) s: D- r11 ( Agfrny et)-
; Water closet
Water heater
- . Other. . . 16.60
Addr
16.60 .
City/ te/Zip: -6 Rs. -14-hoGu- . . -
,,. ..,..mlithbhiillt.Fe iii...,;::::...2:: Other:
Phon . $113 Oa - SS 1 4 S , Fax)3 (09 .1 - 0 qlok
CCB tic. #: -- 7eDLI Plumb. Lic.#:. Subtotal ' S
• Minimum Permit Fee $72.50 S
Authof , •
Residential Backflow Minimum Fee $36.25
Signatu - ....40-- Date-74)1 - Plan Review (25% of Perrnit Fee) _ S
El/ ,' r) # af riga State Surcharge (8% of Permit Fee) _ S .2 . 9 O
(Please print name) . TOTAL PERMIT FEE $ .3?. / S
Notice: . is permit application expires if a permit is not obtained within AU new commercial buildings require 2 sets of plans with isometric or
180 da after it has been accepted as complete, riser diagram for plan review.
• - *Fee methodology set by Tri-County Building Industry Service Board.
1 .
CITY OF TIGARD 24 -Hour-
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION . Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 1, —3 AM PM BUP
Location / 2 -S 1 1 r►wo oc! ; v - Suite MEC
Contact Person - n Ph ( ) Cv c)1— 69' S vrri)
Contractor Ph.( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors 114-e-IL
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
•
Fire Sprinkler
Fire Alarm '
Susp'd Ceiling •
Roof
Other:
Othe
Final
P ASS PART FAIL
PLUMBIN ' A
Post eam �J
Under Slab -
Rough -In
Water Service
Sanitary Sewer
Rain Drains -
Catch Basin / Manhole
Storm Drain
S • er Pan
in r. pe- oK
A PART FAIL
HANICAL
Post & Beam
Rough -In.
Gas Line
Smoke Dampers
Final
PASS •PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Anal Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Eat
Other:
Final . DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL