Permit •
`r CITY OF TIGARD
PLUMBING PERMIT
• DEVELOPMENT SERVICES PERMIT #: P 20/200 -00226
..� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/20/2004
SITE ADDRESS: 12330 SW THORNWOOD DR PARCEL: 2S110BC -05900
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 030 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: Irrigation backflow preventer.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 5/20/2004 $36.25
STE 100 [TAX] 8% State Surcharl 5/20/2004 $2.90
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 RP /Backflow Preventer
Sprinkler Final
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: 444 e L d r,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
May 18 04 02: 22p . dan edmonds 5 0 3 - 6 9 2 - 0 7 6 8 p . 2
Plumbing Per 1 1. tep i-kon Received z- ri . , Plumbing
.:' 41 " . “ 1 Vtij Datealy: ) ,26 by ilo Pear& No.a 0006 Z
anning Appro se.
eity of Tigard Pl DatelBy: Permit No.:
13125 SW Hall Blvd. M: i. 8 2004 PhD Review Other
Tigard, Oregon 97223 Dale/By:. Pamir No.:
Phone: 503-639-4171 Fax; blY54IFIN2 A R D ., . Al f Past-Review LAnd Use
' ' ., i ,i-,
Internet w ww_citigard.or_a UILDING D WiSi 9' :':.'41;:'.:;i1 I ( Date/By: Case No.:
Contact . ._Iwil.: I El See Page 2 for
24-hour Inspection Request: 503-639-4175 '''''''' . - ' ' Name/Method: - HCI 1 Supplemental Information.
: 'TYPE:OF-WORK' . '' .-. ' :- ':-: !t 'j .: • -...; , ::-.:'''.... :FEEt.:SCHED1ULE iiiie.atierikliit) • . *
New construction 0 Demolition _ Description j Qty. I FetIeg0 I Total
Addition/alteration/replacement 0 Other: • - .,...7.: -; .; - 1 , 7.ttillOiiiiiiuktion) ;;:: • : ::-. :. , ,
CATEGORY OF CONSTRUCTION.: ;',:st 7': - t.; - , - ;.;.:.):: :. .
SFR (I) bath 24920
1 & 2-Family dweilm
[] Commercianidus fri al _
:f
SFR (2) bath 350.00
II Acce,ssory Building . 0 Multi-Family SFR (3) bath 399.00
0 Master Builder 0 Other: Each additional bathlldtchen 45.00
.. .. ' . ./OR SITEINFORMATION ind LOCATION: ..;:::: : Fire sprinkler sq. ft: Page 2
Job site address: /:;4330 Tha-r 1v ti 6• ... :::: - .,,f... , -7.:-, ,... ---,.:,-- Sitethilities:
Suite #: 1 BldgJAptit: _ Catch basin/area drain 16.60
Drywellneach line/Much drain 16.60
Project Name: ThVY,10joett.: 1-07 30 .
. Footing drain (no_ linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
S Lt.) PAL/ i rkk no k4). Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision:"Thoril Wc-r_rk, 1 Lot #:36 Storm sewer (no. linear ft) Page 2
Water service (no. linear ft)
Tax map/parcel #: Co f.._;%, Page 2 e›..et.:
': .':. '..-.;'.•:'..? ' ":i , : , F- - feiieleen -- i- . : ....-•..:',. . . - .-
DESCRIPTION OF WORK::
Absorption valve 16.60
LXIFIGMCap C.- lgariCcIOLL) CA-C... Lc E) Backflow preventer j Page 2 , p2'7_ SS
_
Backwater valve 16.60
• Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
13.PROPERTTOWNRIV .:'. : . I" EITENANT:- ...-='-':':...;:':;: :r. ::.:!':.!=.5: _
Ejectorskunip . 16.60
Name: bovi TV) os.s_s_41e. 1--knrrIc-s F..) tank 16.60 ,
Address:A-. 30 Su) &a-62.4,-1o0 ct.) Fixture/sewer cap 16.60
City/State/Zip: Lo-le.___ 0..C.ts-esys g70.35' Floor drain/floor shildhub ; 16.60
Garbage disposal
- 16.60
Phone: Fax: Hose bib 16.60
7SAPPLICANT ': -:: ; ; .::. ' : .: ',' ::. 'RCOPITACTiPERSOP1.•:•..77,:;t':7 Ice maker 16.60
Name: 61 pan-a 1nterceptor/grease nap 16.60 ,
Address: / D...>-0 13 .0.0 rytyclo R Medical gas - value: S Page 2 ,
Primer 16.60
City/State/Zip: -- rualast-t rV.. 0 g:' 6 /70 t a...,
Roof drain (commercial) 16.60
Phone 1+3 (09a- - SR 451 FaxSea tog a.--• 076 g SinirJbasin/lavatory 16.60
E-mail: . Tub/shower/shower pan 16.60
: :-., -: :..1'; . '; ..::;CONTRACTOR. : : .. :-;-:-.. ':.:1;:,:f Urinal 16.60
.
Business Name: 1.../i_rafer-Lpsz_ 0 ro eater 16.60
m Water closet 16.60
c, water h
Address: i D S1- ryl len. Other:
City/State/Ziprataiduh.;‘..., -- t L. 110(0D-- - Other: .
PhOneSea (di - S9'1 FaxS03 GP9.1 - L)' /I4
R .. ,, _: - :i f.i2 --: .• , ,
CCB Lie. #: - 7.e0'4 Plumb. Lic.#: Subtotal $
Mininuun Permit Fee $72.50 S
Authorizet
Residential Backflow mum Fee $36.25
Signam &&24W Date.-A40
Phut Review (25% oflPermit Fee) , S
Eli ell vc rata State Surcharge (g% of Permit Fee) $ .2 , /6
(Please print name) TOTAL PERMIT FEE . $ 39_ / 5
Notice: This permit appReatiost expires if a permit is not obtained militia An 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 Tri-Conoty Build Industry Service Board.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP
Receiv 1 1 /o Date Requested Co/ 0 AM PM BUP
Location ()3 M) 5k4.) 'ropy woud D r . Suite /-04 j MEC
Contact Person -Le6, Ph ( 56 3 ) 9- 01. J PLM a 4 - oo 2Z
Contractor l -- GLSCA -dt,2., 0-e�csv\ Ph ( ) 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 c J
PASS PART FAIL
PLUMBING L
Post & Beam ► I
Under Slab ®kA
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O .-r:
PART FAIL
►` ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL •
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Ej Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA ( `..� �
Approach /Sidewalk Date - 2, 1.4 • Inspector v `• 1 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL