Permit CITY T I GA R D PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00472
" Ail 13125 SW Hall Blvd., Tigard, OR 9 7223 (503) 639 -4171 DATE ISSUED: 10/13/2004
SITE ADDRESS: 12310 SW THORNWOOD DR PARCEL: 2S1106C -05800
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 029 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 backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES [PLUMB] Permit Fee 10/13/2004 $36.25
STE 100 GALEWOOD ST [TAX] 8% State Surchar! 10/13/2004 $2.90
STE
LAKE OSWEGO, OR 97035 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: Z Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.
if uaauaaag .1.• LAaut CJ
Plumbirm Permit AppiR EIVED
FOR OFFICE USE ONLY
City of Tigard OC eceived .
] 3125 SW Hall S1vd., Tigard, OR 97223 OCT 1 3 2004 IN.,: / - 3 0` �l� Permit No.: ' ! � �_ y `A 51.
Phone: 503.639.417! Fax 503.598.1960 Plan Review l
24- Hour Inspection Line- 503.639.4175 }' : �Ij��\ DateBy Other Permit Na.:
Internet: CITY OF TIG - t Date Ready/By: lures _ I see Page 2 for
[nte y�e, R1 1 / f
. • _ ITP IV r _ . • :, .- , 1 Supplemental Information
' .: .•,: �: � � ": 1111; J
• •... .. t_ .. _ < • ' : „ FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist
❑ Addition/alteration/replacement Description I Qty. J Ea.
[] Other: Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
:. :• ;: •• ..: _ '.:' is CATEGORY "OP'; CONS4114.. l?Lt]N,: -. .
.,..�.. .. ... . ..- ;. •:, : .., ._ • ... SFR (1) bath 249.20
1 - and 2 family dwelling 0 Commerciallindusttial SFR (2) bath 350.00
Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other
�- "_ .r0 )3'S1T .. °. Fire sprinkler ( sq. ft.) Page 2
.. i'. Z ..Zr OR.IVIAT, OJ A%. g
' " ' - . • • :• Site utilities
Job site address: / ,p3/61 stu i They-It wane .
Iv B'J��(t/C.; Catch basin or area drain I 16.60
City/State/ZIP: T ► ! �u .&� Q� e "7 )- . ?- Drywall, leach line, or trench drain 16.60
` SuitelbldgJapt no.: Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
� Inn Q� Manholes 16.60
r r `no ` -'O Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision's �Y i„„i I Lot no_Z� Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: LD c; s"" Fixture or item
Absorption valve 16.60
. _., CRIPTION,OF• WORK
Backflow preventer / P age 2 27 SS
L P) Sc. a_ , ; Sri C1 r/ --'t' (._.:7i h ic• 7i i-R-C e.;/,. J;; « Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
: PROPERTY�QWNER:' : ..:< _. ,.,0;- .'ENA ranking fountain 16.60
'
D .
Name: �C�'1 t�(.'I�/ 5 S � : / :• ; : _ Ejectors/sttmp 16.60
r -') i C S Expansion tank 16.60
Address: LA-Z 30 .S Lt,.) 6' ( C C cl 0 OeL Fixture/sewer
cap 16.60
City/State/ZIP:L. A<G (% S (-0 e %C) Q f ' 7 4-33 Floor drain/floor sink/hub _ 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
- APPL:ICAIYT ' r.. : ' . Hose bib 16.60
•.... ; ..r.: ...,.... `: COh1Tic ±PELtSOh! :i .
Business Warne Ice maker 16.60
Cear s e_e/ f -e, Oreq(,m r„,-,,
Interceptor/grease trap 16.60
Contact name: c.11 : ) :Sp fLf7C7 t Medical gas (value: $ ) Page 2
Address: i 2 D-00 c l j; rn J S I /)Yt l( R.i) Primer 16.60
Ciry/State/ZlP: •- a Qh ci a_. + - c 77 , (,-.. 4 Z Roof drain (commercial) 16.60
Phone: (5:3 ) ( . C` - 5ik / . fir Fax - - Sink/basin/lavatory 1 6.60
: �'Yd 1 S
E -mail: Tub/shower /shower pan 16.60
Urinal 16.60
: :' ::••' CON RACl•OR .:.: _ ...:.. >. Water closet • 16.60
Business name: La /Se: f , f o .� ��) �. Water heater
"'�� / 16.60
Address: / crD -(JG S 40 /)') Li S /(fl p Other:
City/State/ZIP: '�,L ., JUQ 7Ulo Subtotal
Phone: (54.3) �' / �i Minimum permit fee: S72.50
(4' Q SS�,S Fax 603) 69 - v'7 ' Residential backflow minimum permit fee: 53625 3 (v . a_ S'
CCB Lic.: 7 ff) Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sig ! l State surcharge (8% of permit fee) e 2 . 10
TOTAL PERMIT FEE�3y , ! S
I Print nameEV �� Dat•;
•!Ol/ 3/ j l This permit application expires if a permit is not obtained s+itfii
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
eukildrita , rmstrusmt.emwApp.dm 12/03 40-46ter(1oiovCOMiwm$)
- • d -- e6E = L❑ .170 E l 403
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested I O _? AM PM BUP
Location l a 3 / v LG9 -4- , Suite MEC
Contact Person Ph ( ) PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing 3 LA4 F to + fac. d
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan /j
Ot - • 4 '
VP
PART FAIL
M HANICAL
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 Hail, 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 Jo) � J n y Inspector I I: +'"'Q Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL