Permit ) '
CITY OF T I GA R D PLUMBING PERMIT
�k DEVELOPMENT SERVICES .PERMIT #: PLM2003 -00518
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 12260 SW WHISTLER'S LN PARCEL: 2S103CC -09800
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 045 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 residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 9/30/03 $36.25
STE 100 [TAX] 8% State Tax 9/30/03 $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
P RP /Backflow Preventer
Phone : 503 692 - 5945
Final Inspection
Reg #: PLM 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
N.
Issued _______r_p_Oa..,,,,,m4,4
C Permittee Si n ature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bu iness day
vi a 03 02:41p clan edmonds 503 - 692 -0768 p. 2
FOR OFFICE USE ONLY
Plum in • Permit A s g lication jived 2 Plumbing �1,,,,
Date/By: 9 ,9 e5 ��4/ Permit No.: di e `J' g
City of igard RECEIVED Planning Approval sewer
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Permit No.:
e ?a60200� � Y.
Tigard, Or gon 97223 Date/By:.
Post-Review Land Use
Phone: 50 - 639 -4171 Fax: 5 98- ,_ 'i'r`'• I ° N, Date/By: Case No.:
Internet: .ci.tigard.or.us �J,, e •' i Contact ! • . El See Page 2 for
24 -hour ectionRequest:
5 4
p► r 'ti "i Name/Method: /P., I Supplemental Information.
ION
FEE* SCHEDULE (fort special information use checklist) '
H ..: ;'_..= � . � . �TYPE.OF WORK .. ‘ . -: :.• f``• D escriptio
New Construction n i Qty. I Fee(ea.) ( Total
0 Demolition _ _ _ • New 1- & Z- family. dwellings
❑ Addi `on/alteration/replacement ❑Other: _ • • (inelnaes;100 ft foreleh Utility connection)
CATEGORY OF CONSTRUCTION .•• - - ".: l g (1) bath 249.20
N.
1 & Family dwelling ❑ Commercial/Industrial SFR ( bath 3so.00
❑Acces ry Building ❑ Multi- Family SFR (3) bath 399.00
❑ Mas r Builder ❑Other: additional bath/kitchen 45.00
' ' .OB SITE INFORMATION and LOCATION - . •, Each additiona Fire sprinkler - sq. ft: Page 2
Job site iddress: /»a{c�C) g4.1 L S Lan' : -" • :- ., ` -.. v. Site1Itilities-l: • • • „•:.
Catch basin/area drain 16.60
Suite #: Bldg /Apt. #:
t ,1J�� (�T Li. S* line/trench drain 1 6.60
Project Name: CO h iss l f'S Footing drain (no. linear 8.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes _ 16.60
/ ,>•/ ST- Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Storm sewer (no. linear ft.) Page 2
Subdividion: W I'usf / C/s a-� -/t_ Lot #: IS W service (no. linear R) Page 2
Tax map/parcel #: Co /• . .. ;• • _;. -: ----, . Fixxtiire Or - Item - ' : . : = ;DESCRIPTION OF WORK •' ' :'..::',:. • - - " . Absorption valve 16.60
LafteliS d.. lgacichoui f.LW I C- Backflow preventer 1 Page 2 _X7. S
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
13.PROPERTY OWNER . : 1 TENANT , " • - -: • Ejectors/sp 16.60
Name: firm M ()YgSSJtf- /-in- rest..S Expansion tnntank 16.60
ct.ER t 'OO GL> Fixture/sewer cap 16.60
Addres :4� 30 S t t) Floor drain/floor sink/hub 16.60
City/St to /Zip: l O- g7 Garbage disposal 16.60
Phone Fax: Hose bib 16.60
LAP I CANT ` CONTACT PERSON' -: Ice maker 16.60
Interceptor/grease trap 16.60
Name: el 1 [.P'1 SPD- a''rdu7 Medical gas - value: $ Page 2
Addr : / �-0 0 Cu) f 1 t n_(j R.b Page 2
City/S te/Zip: - nketictst"l n C) I ail 0 (n Roof drain (commercial) 16.60
Primer
Phone 3 (o9ti. - S 45 I Fax:503 log al- 0710 g Sink/basin/lavatory 16.60
Tub✓shower /shower pan 16.60
E -mat : Urinal 16.60
• • :. • • -� '' -7}.: :-'' :' : _ Water closet 16.60
Water heater
Busin4ss Name: v1dSCn O�` QY� G 16.6 i
Addres: la - oo Sup i nl gtdmy len- • Other: .
City/ ate/Zip: Ao - ;•-- R- Cr] otoa' Other
Phone e.3 (Ea - SINS FaxSCI3 (Rd - 0710 r? . • ••Plumbingyeriitit .5 .2 7,55 -
CCB ic. #: - 7ery -f Plumb. Lic. #: Minirrtum Permit Fee $72.50 S •-31-0 0 �5
Autho . R1a9�3 Residential Backflow Minimum Fee $36.25
Signatu • 'L e..4./ -G�'LY Date Plan Review (25% of Permi ee) s
Eli /I f � Pen
nit Surcharge (8% of Perit Fee) s .2 . 9
%Oa (Please print name) PERMIT FEE $ 39. / 5
Notice: is permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 day after it has been accepted as complete. riser diagram for plan review.
*Fee methodology act by Tri -County Building Industry Service Beard.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
.INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 11- AM PM BUP
Location / W kiS#fe.✓S L.rt - Suite MEC
Contact Person j4 Ph ( ) A ` 7 2 - ,5945 42, 3 -0057g
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation i , ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors / �,
Ext Sheath/Shear '3 acK �f° w f � rr`SP •
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: c�
Final
P S T FAIL
LUMBI
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Other: , A:: V •
Other: ���5
in
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 ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / Inspector Ext
Other:
Final ' O NOT REMOVE -this- Inspection- rocord the-Job site. - --
PASS PART FAIL