Permit )
CITY TIGARD PLUMBING PERMIT
4 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00523
l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 12285 SW WHISTLER'S LN PARCEL: 2S103CC -11100
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 058 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 STE #100 [PLUMB] Permit Fee 9/30/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 9/30/03 $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
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
Issu d B OA II. I •
By: � P ermittee Signature: _JO 4 /"y zorzes 7 1
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next • usiness day
Sep 29 03 02:55p dan edmonds 503-692-0768 p . 2
A l k
IguMbing Permit Application Received , / FOR OFFICE USE ONLY
Plumbing )
0
¶t Date/By: X7,9 4 5 /44/ Permit No.: /.../Y,9‘45 --4,65.93
City f Ti EC E1VED Planning Approval
Datr/By: Sewa-
Permit No.:
13125 S Hall Blvd. Plan Review Other
Tigard, regon 97223 cp, 9 e li Date/By: Permit No.:
Phone: 03-639-4171 °VAX: kS63- 50V1960 Post-Review Land Use
Date/BY: Case No.:
Internet:1 www.citigard.or.us _14. I Contact Juris.: I 1$1 See Page 2 for
24-hour Inspection RAiTatP gsb-CMP 175 '''''''''' -- Name/Method: - fr - 6, I Supplemental information.
BUILDING DIVISION
-
1 :: : TYPE OF WORK ' .- ' - -: : :..','''' ''' ,•. : - . TEE* SCHEDULE (for SpeCial InforitiatIon lise "checklist) • .
ID Newl construction El Demolition Description I Qty. I Fee(ca.) 1 Total
111 Addition/alteration/replacement 0 Other: New -I- &I-family, dwellings: .- .- , • •
......L.,.: .' :-: - .-' (itiehiCtei tall*. 6i-7r:id] utility connection)
CATEGORY OF CONSTRUCTION ... : :,-, v :',..;.; ' ''..
SFR (1) bath 249.20
0 1 & -Family dwelling 0 CornmercialAndustrial SFR (2) bath 350.00
DAcceisory Building _ . 0 Multi-Family SFR (3) bath 399.00
0 Mast* Builder 0 Other: Each additional bath/kitchen 45.00
• . 3I0B SITEINFORMATION and LOCATION , ' ''..' • Fire sprinkler - sq. ft.: Page 2 _
Job site ddress: /AD-E LW tAN/Listicrl La
Suite #: I 1 BldgJApt#: Catch basin/area drain 16.60
Drywellileach line/trench drain 16.60
Project ltiame: (...,0 it-4' $' lict 4 0 a Lbr E
F ooting drain (no. linear 11.) Page 2
Cross stieet/Directions to job site: Manufactured home utilities 110.00
SlA l - c-T A-Lic.._. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivislion:Whis 1 - pe,r ,S L 0 cLUc, Page 2 I no. Lot #: .5? Storm sewer (no. linear ft.) Page 2
_Water service ( linear ft)
Tax maPipareel #: (p .. 5 6 5
= • _ . ...' - . :', - `: . ." "Filititre Oilterri
''', . • „ • ' I . • 's 'DESCRIPTION OF WORK : -::''':-. . ,, • ..,
Absorption valve 16.60
LAM a.1)e.... - 4:ac.lci- - Mu.) aCii i c.e) Bacicflow preventer / Page 2 .77. SS"
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60_
Drinking fountain 16.60
'.PROPERTY OWNER - - I 0 -TENANT ''- -2 - .. '. :.-' •.. , - t Ejectors/sump 16.60
Name: 1)61, m(yy'lszilek- kdorne-s Expansion tank 16.60
Address,:4A 20 S.u) &aza_tx3oo a..› Fixture/sewer cap 16.60
City/State/Zip: i,o-le_. ostue_56 Q1C.).3S Floor drain/floor sinlc/hub
. - 16.60
Garbage 'disposal 16.60 ,
Phone: Fax: Ho= bib 16.60
ISAPPLICANT ' „ , - - • CONTACT PERSON ,-: — Ice maker 16.60
Name: iIi jai Sparrzrz0 Interceptor/grease trap _ 16.60
Address: I D- 0 CIA i119.giont,i 12D , Medical gas - value: $ Page 2
CitY/S eiZiP: - RA.a-tel3h N... CD R. 9'1 o 4 a_. . . :6 6.60
6
Phone 3 (.09.1- - -9IILS 1 FaxS53 9 a.
(0 o% g s iPz i rin i er ibas f da rn/is: En t:7; 1'4w)
E-mail:
. Tub/shower/shower pan
1
16.60
; • '. ..,..:, -.:-:. -':';',.
16 60
Busines Name: Lo_ncl...fcapt 0 re -r_ _ WwUri:atererai :
h d eat ose e t r
. 1 6 6. 6 6 -
Address 1 >-Oci Su- rYttm_y eta- Other
City/State/Zip:mittuLcut,.;:..., R._ cr a- Other
PhoneSt3 (dj, Vit./5 Fax S)3 Co94 - 6 e ,-- -- •. •• - • ,-...... Plunibing Fees! '.:2
Subtotal $
CCB Li '. #: - 7eD1-1 Plumb_ Lic.#:
Authorized _ _40‘14.A_az" Dat ("7--ct(92 Residential Bac F F $ . 3 40 - a ' S
Signature.
Plan Review (25% of Permit Fee) $
Eli \c rala .2
(Please print name) . State Surcharge (8% of Permit Fee) S . 96
TOTAL PERMIT FEE $ .35.. / 5
Notice: miii permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
ISO days aft 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" `■F Inspection Line: ( 3 9 -4175
INSPECTION DIVISION . Business Line: 50 3 71 MST
/ BUP
Received Date Requested !O - .39 AM PM / 6 2-----
Location /2 it S e✓`5 1-..n • Suite MEC
Contact Person i -�'�"` Ph ( ) 6,9 2 — 5 qr Op 3 - 005. .23
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab - Inspection Notes: SIT
Post & Beam •
Ext Sr Sh ea t h /SSh Ui�
Ext eah/hear - / /oW / iL S Pcho-)
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
•
Final
PASS__ PART FAIL ,
�P LUMBII ATIMMIMIRI
Poster Beam
Under Slab Rough -In � �
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pay?
•h - : ..
O"ina�
6 FAIL
CH : - CAL
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 - G
ADA D
Approach/Sidewalk
Date I Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL