Permit A
C ITY OF TIGARD PLUMBING PERMIT
; $r l�► DEVELOPMENT SERVICES PERMIT #: PLM2004 -00457
.,I DATE ISSUED: 10/1/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12051 SW WHISTLER'S LP PARCEL: 2S103CC -14600
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 093 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 backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES [PLUMB] Permit Fee 10/1/2004 $36.25
STE 100 GALEWOOD ST [TAX] 8% State Surcharl 10/1/2004 $2.90
STE
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 #: 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: _ J'_Z,11Z36 Permittee Signature: ,.e_ (� ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busines day
w
- Building Fixtures - NE
Plumbing Permit Appli b.'! . 1
FOR OFFICE USE ONLY
City of Tigard S o 'LW' Receives r.
1 I ZS SW Hall Blvd., Tigard, OR 97223 ��� /,' , C ] ® Date/By: ? / Permit No / M 7n riC� 0 �.,7
Phone: 503 - 639.4171 Fax: 503.598.1960 (* T! 6 � PIin Review 4i t/ 7 /
24- Hour Inspection Line- 503.639.4175 G1�Y _ r 1 ' ?•1I� � " Date/By: Omer Permit No.:
Internet: www.ci.tigard -or.us (S t1L®�ty 4 - Date Ready/By:
peri @i See P 2 or
l� Nodfied/Method:
S:ppteme: ta! [
. = :- - •%. -;1. F._ ' ,_1 WORK - FEE'' SCHEDULE
isQ construction ❑ Demolition For special information use checklist
I ❑ Addition/alteration/replacement 0 Other- Description I Qh . I Ea.
Total
New 1- 2-family dwellings (includes 100 ft. for each utility connection)
:CATEGORY OR : CO,lVSTkUCTlON (1) bath
-��� SFR 1 bh 249.20
` R1- and 2- family dwelling O Commercial/industrial SFR (2) bath
❑ Accessory building 350.00
❑ Multi- family SF R (3) bath 399.00
Each additional bath kitchen 45.00
❑ Master builder 0 Other:
TOB'S;W(roR t L ` Fire sprinkler ( ft.) c 2
q r,F . 1Y,$ND OCAT . e sq. ) Page
Job site address; '•�. ' " •� - �'•`. Site utilities
l C.ct�P Catch basin or area drain ! I 16.60
�
City/State/ZIP: 7 yam O(C. 'i 70 7 a-3 Dtywell, leach line, or trench drain
/��t - � � 16.60
Suite/bldg./apt. no.: I Project name h /Sj - /.0 /S W kZL (-i - 93 Footing drain (no. linear ft.: _) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
S C- i a. i �7 i - U Manh
a 1 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: ( St Wa 1 k =r I Lot no.: 93 Water service (no. linear ft.: ) Page 2
Tax map/parcel no.: (Q S S a S Fixture or item • ,, -, . , ,'DESCRIPTIOi` OF WORK Absorption valve 16 60
' ^ - Backflow preventer / Page 2 ' a 7 , S. fs
C r) SC.l.'!- f, i i-r/ c J t7 %; "•%) • (tee_ C�ZL : -: r / ` Backwater valve
16.60
Clothes washer 16.60
Dishwasher • 16.60
PROPE OWIV�R. ; f . : 0': rj r • Drinking fountain 16.60
Name: +� Ejectors/sump 1660
D • / r: /' Y)(;y-/ S .5 _f f / `YYl C.-
Address: - f cl 3 C.-` S Li...) C >c'�. ( c C & 0 CSC
Expansion ter cap 16.60
L. Fixture/sewer cap _ 16.60
City /State/ZIT:[x2 / <. (1 t t V c jc. Oft GJ - 7 Cs_ 3 5 Floor drain/floorsink/hub
Phone: ( ) 1 16.60
Fax: ( ) Garbage disposal 16.60
- .
._ APPLICAT : r ' - CONTACT PERSON Ho bib 16.60
Business name. Lard �� lire Ice maker 16.60
r-• ! o -7, Z>� `s Interceptor /grease trap 16.60
C , /
Contact name: ./ I ....Sp a.rKCLC.r
Medical gas (value: $ ) Page 2
Address: / ) ) DC S W r y., / rri t�
J � �f� Primer 1 6.60
City/State/ZIP: tat ittirt. , G p___ J . , 7 -7,-, ( . , Roof drain (commercial) 16.60
Phone: (5tt 3) (-3 9.:4 -Seivs I Fax:: (.5c) 6- Y:� - C' :. S' Sink/basin/lavatory 16.60
E -mail: Tub/shower /shower pan 16.60
Urinal 16.60
.•. GON>RACTOR
Water closet 16.60
Business name: i - {nL,SCct j•e are /(ryi �� C Water heater
R--0 ,� I 16.60
I Address: / S i. / - J Al V .S- f t Yl IZ-c Other: I
1 City/State/ZIP: ' . ./ f2 ` 7000 -�- Subtotal
Phone: (�.3) &Q S .S Fax �G Minimum permit fee: 572.50
y lJ • ) 4,9Q - 074, 3' Residential backflow minimum permit fee: $36•25 3 (0 - , ;-/-1
CCB tic.: 7 L) Plumbing Lic- no.: Plan review (25% of permit fee)
■
Authorized signa �� State surcharge (8% of permit fee) ■ 9(_,
Print name �� I TOTAL PERMIT FEE 3y, /
Dat. J30 jai 1 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
■ �enerrromwt 4 F -Pe rnitAPP•doe :2/03 'Fee methodology set by Tn -County Building Industry Service Board
440 a6ler'(IaovCOM/WEB)
.1 -d et 1,0 DE daS
CITY PE TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
!` BUP
Received / �/ J Date Requested AM PM BUP
Location /7 O Sl � e ,, 0 Suite 93 MEC .
Contact Person � � ' Ph ( ) (Q:_.2 — PLM �` - o 0 1 7
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 e. 5 t f cc__ ___
Insulation >
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other,: - .--/
Finales
P PART FAIL
LUMBING _
Post
Under Slab `. -`/
Rough -In
Water Service -
Fr
Sanitary Sewer .
Rain Drains .,
Catch Basin / Manhole
Storm Drain ' • " �,.'
Shower P n i Yl�✓ ,f"
Other: �� ,-
F
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: 1=1 Unable to inspect — no access
Fire Supply Line
ADA � I � / � � 1V/J�o _
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL