Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES
- PERMIT #: PLM2004 -00420
..��I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/13/2004
SITE ADDRESS: 12290 SW THORNWOOD DR PARCEL: 2S110BC -05700
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 028 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
4230 GALEWOOD ST., #100 [PLUMB] Permit Fee 9/13/2004 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchari 9/13/2004 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 - 692 - 5945
Final Inspection
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By :- I . Permittee Signature: _ .{_ cs, T p
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busine day
Aria aluau% R• 4114.LU1 VG*
Plumbing Permit A pplicatRECEIV D FOR OFFICE USE ONLY
City of Tigard Rece;ved /�
13125 SW Hall Blvd., Tigard, OR 97223 SEP 1 004. Date/By: 7 / '- 9' .i PermitNo�1 � a / V.LO
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review JJ 7
24- Hour Inspection Line: 503.639.4175
4'tt` .r...:'I �, Date : Other Permit No.:
tl.. Y
Internee www.ei.ti CITY OF � ; � �.' Dale Read
gard.or.us
1 See Page 2
D( IH . Nodtied/Melhod: / (
TP - • INI$IQN ,WO Supplemental lnfarm uion
-
Ci EDUL.E
New construction ❑ Demolition For special information use checklist
Description I Qty, I Ea. 1 Total
❑ Addition/alteration/replacement
❑ Other.
New 2-family dwellings (includes 100 ft. for each utility connection)
• - • 1- 2 Tamil d welll n
_ F _ .::: : .- C ATEGORY • OF CO.1STR(JCTTOS : . ' ' : _ • SFR (1) bath 249.20 l
1 and 2 family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi - family SFR (3) bath 399.00
❑ Master builder Other Each additional bath/kitchen 45.00
~'� _ SOB °SI7" , Fire sprinkler ( sq. ft.) Page 2
..Pi.. _ITTO hIATI01!lT.: ;LOCA'it'ION. Site u g
• _ �" , " ' tDities
Job site address: / ), C` SW •Tneyn LE :00,C
4)6 C. Catch basin or area drain 16.60
City/State/ZIP: T .; y LtAtt 4 L y 7 ma y Drywell, leach line. or trench drain 16.60
Suite/bldgJapt. no.: ( Project name: _T Lt) LV r a g Footing drain (no. linear ft.: ), Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
S et u.. j ' m try yy�� Manholes 16.60
` V Rain drain connector
16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: - ) Page 2
Subdivision: r ,- UU O Water service (no. linear ft.:
I T Lo t ao.: 2S Page 2
Tax map /parcel no.: t0 G S to Fixture or item
@ f2 Absorption valve 16.60
. _ • - :'D
.ESCRIPTION OF VYO • -
. ... .- .' ..
:.. Backflow preventer / Page 2 .2_ 7.. SS
Z-Ce-r) Se' u_ 1°, i, r, c 0_7'7 0 i Ci -rlc in.!,) _:/p ; / / - Backwater valve
16.60
i
Clothes washer 16.60
Dishwasher 16.60
-
PROPERTY �QWNE . Drinking fountain 16.60
. Ejectors/sump 16.60
Name: b /ih p c q s r5 C'_ 7 t / -yi7 C .. Expansion tank 16.60
Address: Z1L 3 L, S ( fi t &&:c. f e cu 0 t_1CL. Fixture/sewer cap 16.60
City/State/ZIP:LcA.. k_ C• 1. is U C I c) v k. y . 703 5 Floor drain/floor sink/hub 16.60
Phone: ( ) f F ax: ( ) Garbage disposal 16.60
PPI:CCANT: h Hose bib 16.60
:: ; ., A .:: '`. j, CUNTA :PE -
.. .. -. Ice maker 16.60
Business name:
L O L r , c 1 s r r c _ i p °/ cy T� C, Interceptor/grease
Contact name: Ell �� S J trap 16.60
L�/ "f�C `, � j Medical gas (value: S ) Page 2
Address: / a -D-DC) S , Lt) r}rl tiS,.I /WI 4( (L1) Primer 16.60
City /State ZIP : - t - 1 1 ((l G � , 7 - 7G, �, : � Roof drain (commercial) 16.60
Phone: (503) J e'' / - J��U5 I Fax: : (5' ,3) r/..,a - [• 'A:', i Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
Urinal
CONTRA
°:. 16.60 • �. .• . . ..i. . . .. : .. .C`,�OR . : _ ..'.'. ;•:: • � , .. Water closet 16.60 I
Business name:L ear exp. err f/a71 c Water heater 16.60
Address: /,?,) S (/.� in Li unti i p Other:
City/State/ZIP: ' hrt ` 70' :1- subtotal
Phone: //__// Minimum permit fee: $72.50
) & ,1 S Fax: (5 3) (,9 - 07c, g• Residential backflow minimum permit fee: 536.25 316 .
CCB Lie.: 7 et.) Lic. no.: Plan review (25% of permit fee)
�
Authorized signa 7 State surcharge (8% of permit fee) . , TO
TOTAL PE RMIT FEE 31 , / 5
Print name`/ f $ I D I l3 J Otj This permit application expires if a permit is not obtained N Jain a ��� J t / 180 days after it has been accepted as complete.
t *Fee methodology set by Tri- County Building Industry Service Board
isfileldinglPa n1PLMF- PiumitApp.dac 17/03 440- 1616T( icuovcOM/WBB)
Z'd eLEs60 170 ET daS
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 2 3' AM PM BUP
9 �m�ti� i
Location Ite MEC
Contact Person Ph ( ) PLM 6 / 2 6
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 -
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
Other: 60 ` I
irga FR_
faMg 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
El PASS PART FAIL Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE El Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date i 2.3) 54 Inspector CP 6‘....); 11'x,..1_. Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL