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Permit A, CITY OF TIGARD PLUMBING PERMIT � DEVELOPMENT SERVICES PERMIT #: PLM2002 00496 I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/23/02 SITE ADDRESS: 12125 SW WHISTLER'S LN PARCEL: 2S103CC -WW048 SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5 BLOCK: LOT: 048 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: Back flow preventer at monument to subdivision. Per Don Morissette Homes, the property owner at this address will be the responsible party FEES Owner: Description Date Amount DON MORISSETTE HOMES INC 4230 SW GALE WOOD ST #100 [PLUMB] Permit Fee 12/23/02 $36.25 LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 12/23/02 $2.90 Total $39.15 Phone : 503 387 - 7538 Contractor: PROGRASS LANDSCAPE SERVICES 29895 SW KINSMAN RD WILSONVILLE, OR 97070 REQUIRED INSPECTIONS Phone : 682 - 6076 RP /Backflow Preventer Reg #: LIC 6136 PLM 1 1558 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 Issued By: /1/4-8-1-7110-1--e— Permittee Signature: 4 Call (50639 -4175 by 7:00 P.M. for an inspection needed tt next business • li Plumbing Permit Application Date received :42 ,/n 23/0 Permit aeb2 - pbvq t Ci of Tigard � � �� City b Sewer permit no.: Building permit no.: Address: 13125 SW Hall.Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: l Expire date: Fax: (503) 598 -1960 Date issued: By: I Receipt no.: Land use approval: m Sna DV - - it 1-0 Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: (2_I Z5 hj 1 , , . .ij ' s � Description Qty. Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: 1 (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: 6Sc 8—s— SFR (1) bath Lot: 'Block: I Subdivision: SFR (2) bath Project name: G1na/ < W tt_ fl/( - a 61 t.Pct"' SFR (3) bath City /county: / 1 k/A I ZIP: 9 ? 17—)f Each additional bath/kitchen De c� ription and cation o work on premises: Site utilities: � j�l�l1 C/4p Catch basin/area drain Est. date of completion/ins jtion: d Drywells/leach line/trench drain • PLUMBING CONTRACTOR Footing drain (no. lib. ft.) Manufactured home utilities Business name: _ a G - -- - - -_ -- - -- -- - -_ - -- - - � O �'� -� - - r.)-S� - -� _ -= Ma nholes- - - __ - _ -_ _ - -- - - - -- Address:c2G� ! -- 1 k f5 Achi A..Vt/ A- d - Rain drain connector • City: /// 1 4„. 11/ i / (.� State f})/' I ZIP:/q0:7-0 Sanitary sewer (no. lin. ft.) Phone: (o a 6.4 I Fax:Gg2,jg7 E -mail: Storm sewer (no. lin. ft.) CCB no.: (o / 3.6 Plumb. bus. reg. no: Water service (no. lin. ft.) City/metro lic. no.: Fixture or item: Contractor's representative signature: Absorption valve i� � flow preventer Print name J r � ETC a j,p _/f • / z ��' Back flflow 0 Z Backwater valve CONTACT`I'ERSON 1 Basins/lavatory Name: ' ^ 17-6 ' . -e •r2..Sdk1 Clothes washer Dishwasher Address: 05 Sk/ ik A 1441._ Drinking fountains) City: I J �' tJ1r 0 ` tately I ZIP:' f0?" d Ejectors/sump - E -mail: l Phone: , , to F ax >Lg2 Expansion tank OWNER Fixture/sewer cap Floor drains/floor sinks/hub Name (print): Garbage disposal Mailing address: Hose bibb , City: I State: I ZIP: Ice maker Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Name: Urinal ame: Water closet Address: Water heater City: I State: I ZIP: Other. Phone: I Fax: I E -mail: Total Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ rm ❑ visa ❑MasterCard Plan review (at _ %) $ IIIIIr expires if a permit is not obtained b � Credit card number: / / State surcharge (8 %) $ 1 Expires within 180 days after it has been Name of cardholder as shown on credit card accepted as complete. TOTAL $K,- S $ -- _ -r. ;i;.;♦ Cardholder signature Amount y - , u j ',`�";.,La; • • m • .16 ., r r /COM) • PLUMBING PERMIT FEES: Mr PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT 16.60 for each utility connection) Lavatory One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16 60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain /Floor Sink 2" 16.60 3" 166.660 0 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity b/ Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16 60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3" Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Other Fixtures Water Service - each additional 200' 46.40 (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 - Commercial Back Flow Prevention Device E.66 --.. Residential Backflow Prevention Device' 27.55 Catch Basin 1 Inspection of Existing Plumbing or Specially 72.50 • Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is > 9 . *SUBTOTAL 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty total is > 9 TOTAL $ * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow . Prevention Device, which is $36 25 + 8% state surcharge O ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. i:\dsts\forms\plm-fees.doc 10/10/00 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Request d - AM PM BUP Location I a ( as (,) V Suite / MEC Contact Person Ph ( ) t2 ° ? ?° PLM 2 -c Contractor Ph ( ) a4 1 SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: 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 — y 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 , 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 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 OT REMOVE this inspection record from the Job site. PASS PART FAIL