Permit aft
CITY TIGARD PLUMBING PERMIT
il DEVELOPMENT SERVICES PERMIT #: PLM2003 -00635
r � lll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/22/03
SITE ADDRESS: 12385 SW THORNWOOD DR PARCEL: 2S1106C 04700
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 018 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: Install irrigation backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 12/22/03 $36.25
STE 100 [TAX] 8% State 12/22/03 $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
Final Inspection
Reg #: LIC LCB: 7804
PLM ALL PHASES - PLL
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 B 4 Aw-4-_, Permittee Signature: GM
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Dec 19 03 11:54a dan edmonds 503 - 692 -0768 p.
% ...gybing Permit Application
Received OFFICE USE ONLY iyed Plumhin
Date/By: l a' Z13 � ®o --00-3S � Permit No..
City of Tigard Planning A royal
Date/By: Sewer
,''' . , ,. Permit No.:
13125 SW Hall Blvd. Plan Review Other Oregon
Tigard, Ore on 97223 1 fi Permit No.:
. _:« DatrJey:.
Phone: 503- 639 -4171 Fax 509H`19� .. , �
i . p - '�� 1; ' � � "` Post-Review Land Use
Internet: www.ci.tigarcLor.us BIN DIN"' ` + t�" Date/By: Case No.
t ' I+
�_ l .W Contact J El See Page 2 for
24 -hour Inspection Request: 503 -639-4175 Name/Method: Supplemental Information.
: TYPE OF.WORK ". FEE* SCHEDULE.(forspecial information use checklist)
❑ New construction ❑ Demolition r Description J Qty. 1 Fec(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New - 8t2- family :dwellings >.'
CATEGORY OF. CONSTRUCTION (includes ^1110 R for each utility connection)
❑ 1 & 2-Family dwelling SFR (I) bath 249.20
y g ❑ CommerciaUlndustrial
❑Accessory Building , ❑ Multi -Famil SFR (2) bath 350.00
�' SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen
' , JOB SITE INFORMATION and LOCATION - 45.00
Fire sprinkler - sq. ft.: Page
2
Job site address: / 13 S'S Stu i osr f/titi.
S uite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: '7hLrn u Ceocl_ 1-� 7- / k Orywell/leach line/trench 16.60
Cross street/Directions to job site: Footing drain (no. linear ft.) page 2
Manufactured home utilities 1 10.00
s -i..i I -t i 1 )'v■ 1 N. 1,C-0 . Manholes 16.60 _
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision:--y h t_:.:LC:C� 1 Lot #: I E Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: (p S s 6 ( Water service (no. linear ft9 Page 2
. :' DESCRIPTION OF_ WORK - : _ . : : t
- o It em
F u'reor
C, Absorption valve 1 6.60
c
0 '� h�� �� L C � Backflow preventer 1 Page 2 „2"7_ SS
-
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER : : .. J 0 TENANT:: :....
Drinking fountain 16.60
Ejectors/sump 16.60
Name: Dori TV) I i_ kicync,S Expansion tank 16.60
Address:9-. , 30 1.0 &LI a py00 a., Fixture/sewer cap 16.60
City / State /Zip: 1.0_-1 - 0Sive Q ) Floor drain/floor sink/hub • 16.60
Phone: Fax: Garbage disposal 16.60
Hose bib
:laAPPLICANT ' CONTACT :PERSON l: `. : ::" :' Ice maker 16.60
Name: Ella) .p o-r - ► - tZ t,3 Interceptor /grease trap 16.60
Address: ID- O 0 C1 nri -1 9 R,D Medical gas - value: $ Page 2
City /State/Zip: .& Q'�lty, 0 i2 970 (a a_ Primer 16.G0
j
Phone Sea (o 9i.. - Sy 1 15 5 I Fax:953 (o9 a- 07/o g Roof as(commercial) 1 6.60
Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
. `• :: CONTRACTOR::. ' :... c .: ' -. :': := . : :. Urinal
Business Name: L r UCa.po p r yer t Water closet 16.60 16.60
Address: I a-a-OO S r Ii& J � Water heater 16.60
/State /Zi 2O(o Offer.
Ci
h` p- L�` � 1 - Other.
Phone 5i (tea - 02 y S Fax a)3 (o - 671 e ' Plumbing Permit Fee`s '':' . : /7,SS" :
CCB Lic. #: "71-/ Plumb. Lic. #: Subtotal $
Authorized / , _ Minimum Permit Fee $72.50 $ 3( -
m
Signatur � - 1 �L�) Dater I' ! (c3 Residential Backflow Minimum Fee $36.25 _
car ratO Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ e:? , ! O
(Please print name) TOTAL PERMIT FEE $ 37. 15 _
•
Notice: This permit application expires if a permit is not 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 Tri- County Building Industry Service Board.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Y Z 2 ( - I (0 D to Requeste /— 2 3 ` O4 AM PM • BUP
Location / 2-.3 . Suite /& l ? MEC
Contact Person Ph ( 5() (o r S <I s 41251. e 3 5
Contractor d 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 Ban
=�
r. Q�
Fin
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 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 Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL