Permit 'CITY OF TIGARD PLUMBING PERMIT
I" DEVELOPMENT SERVICES PERMIT #: PLM2004 -00507
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/8/2004
SITE ADDRESS: 12365 SW THORNWOOD DR PARCEL: 2S110BC -04800
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 019 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: Backflow preventer
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD STE 100 [PLUMB] Permit Fee 11/8/2004 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchari 11/8/2004 $2.90
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
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' - / /
Call -4175 by 7:00 P.M. for an inspection needed the next bus ness day
l
Building Fixti"i'res
Plumbing . Permit Apt tad. IvE .
1..
City of Tigard
D FOR OFFIC£ USE ONLY
Received � /T7,
■ p , Date/By: Permit NO.:t`/iOZiC04 "ero G�j-
13125 SW Hall Blvd., Tigard, OR 97223 7
Phone: 503.639.4171 Fax: 503.598.1960 N V '' -.4 200 ��„i Plan Review T �" l
24- Hour Inspection Line: 503.639.4175 t p " '.! J Date/By: Other Permit No.: /4579401".44;4:;9
Internet: www.ci.tigard.or.us GITY OF 71G - Date ReadyBy: luris: Supplemental See Page for
�,QQ �Q� Notified/Method:
•T Y PE'14b;IWORIi: u11t.i 6dormaUOn
' FEE* SCHEDULE
C1 \ New construction El Demolition For special information use checklist.
❑ ddition/alteration / replacement Description I Qty. Ea. 1 Total
❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
. • CATEGORY OF CONSTRUCTION SFR (1) bath I 249.20
1 - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
Accessory building ❑Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder 0 Other:
. - .,, JOB SITE INFORMATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Site utilities
Job site address: is 3 (r, 5" SdA..) "morn W O2/
t� , C atch basin or area drain 16.60
City/State/ZIP:
T j y cifAC�- OR_ Gf 7 a- 3.3 ry
� Dwell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project namerThort w 9 2/ for , Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
.u) r� „ , / I � FA) /2-0 Manholes 16.60
' !7 " 1/LG/ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: n ) cJ }Lot no.: J9 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or Item
Absorption valve 16.60
• 'DESCRIPTION OF WORK •
Backflow preventer i Page 2 ,p. . S' S
LC-4,14...0
�-apc, irr/ q (}'1 ar _e f (Jl ,, L 1 ci f _ y / , , Backwater valve 16.60
cap c,
Clothes washer 16.60
Dishwasher 16.60
_ PROPERTY., OWNER: Drinking fountain 16.60
`..: 0 :TENANT .
Name: 7� Ejectors/sump 16.60
F/f'1 than s s e t # Hay y) t2/5 Expansion tank 16.60
Address: L ia 3C> S LL) 6G�.( e•e."00 or
'L- Fixture /sewer cap 16.60
City/State /ZIP:(.C1_ke 0 503 . 'j 0/2 9 .703 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal
APPLICANT • `• Hose bib .
16.60
. .. . . CONTAC P ERS O N 16 60
Business name: 5 Ice maker 16.60
C�'� �� ��� Interceptor /grease trap 16.60
Contact name: J en S �i�O t�
Medical gas (value: $ ) Page 2
Address: ` - a-()Q ) rn J 7 +imt Primer 16.60
City/State/ZIP: / Oa_ , e j 7G Roof drain (commercial) 16.60
Phone: (503) (p % - -.j9ys I Fax: : (5 (. fi.R _ 0 76 , Si Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet
16.60
Business name: n aSC L . £-- �� C, Water heater
`"�r - ' 16.60
Address: / ?'a'oc S l) AY1 I , f gin Other:
City/State/ZIP: �/ " 12 f . '4'70(6 - Subtotal
Phone: &Q, 5 3) & Fax: (503) ( ? - 0'7 Co S+ Minimum permit fee: $
Residential backflow minimum permit fee: $36.25 3 to
CCB Lie.: 7 gU Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sigma - 90
.t /
TOTAL PERMIT FEE a9. 7..s
Print namee ? J" , J \ _
Dat /, 4f l� ft This permit application expires if a permit Is not obtained within
� 180 days after it has been accepted as complete.
;:�Bo;tam *Fee methodology set by Tri -County Building Industry Service Board.
gWennitslPLMP- pcnutnpp.doe 12/03 440 461.6TO0/02/COWWSB)
z - d eTT =iT 40 40 AoN
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ! ! — 7 AM PM BUP
Location _ '% _ .1d Lc)/ LC Suite MEC
Contact Person Ph ( ) PLM o Y *S7
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 lAIF
Fire Alarm j i V
Susp'd Ceiling
Roof
Other: -
Final 140
PASS PART FAIL vor - DP" —
PLUMBING
Post & Beam / o
Under Slab
• �� _ (
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
sue!■
S PART FAIL
CHANICAL
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 fl Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA `�
Approach/Sidewalk Date v 1 Inspector gr?) Ext
Other:
Final O NOT REMOVE this inspectio4 record from the job site
PASS PART FAIL