Permit A Ito CITY OF TIGARD PLUMBING PERMIT
IA DEVELOPMENT SERVICES PERMIT #: PLM2004 -00403
A I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/2/2004
SITE ADDRESS: 12050 SW WHISTLER'S LP PARCEL: 2S103CC -11900
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 066 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 INC [PLUMB] Permit Fee 9/2/2004 $36.25
4230 GALEWOOD STE #100
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharp 9/2/2004 $2.90
Total $39.15
Phone : 503 - 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 - 692 - 5945 RP /Backflow Preventer
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: t���C�� Permittee Signature: e-e Ps T,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi day
,w - It
4)
Plumbing Permit Application
City of Tigard
Received
FOR OFFICE USE ONLY
� eceved
13125 SW Hall Blvd., Tigard, OR 97223 t`/ ilk•
R V 1 1 1 t!Q �� Permit No.�0 Phone: 5 03.639.4171 Fax: 5 03.598.1460 • Q ` [ - 3
24- Hour In ' { tn' �' Other Penn;[ Nor
s p 9.41 Line: 50 39 98.1. (f'` G • .
Internet: www.ci.tigard.or.us
t a - ' - 7! I Date Ready/By: pall di Notified/method/ See Page 2 for
_ _ . • . T,YP �,VO -'. ; '7-;.",. .- Supplemental information
!� EE - SCHEDULE . _" constructio n y_ - ...„ , _ _ F •
❑ Demolition ,,, Far s, ecial in armarian use checklist.
❑ Addition/alteration/replacement Dtscri.tion
Other: EON Ea. Total
❑ O
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
LI CATG012Y ORCONSI6tUCT10N
1- and 2- family dwelling SFR (I) bath 249.20
❑ Commercial/lndusniai SFR (2) bath _
SFR (3) bath 350.00
❑ Accessory building p Multi- family
399.00
Master builder
0 other Each additional bath/kitchen _
45.00
'' '''...i.- . . 1 ,.' ,JO `S 4 '•� Fire sprinkler ( sq. ft.
E 1.1!FFOq.*iXX4Ni;*1 LOCA�PIONI' `;.-: ,� . 4 ft.) Page 2
Job site address: ) _S4,0 1,0h i ., -/- ,- Site utilities
?-) .. C 7 _ Ai
Catch basin or area drain 16.60
0.44-t_ Q�' D-3 Drywell, leach line, or trench drain _
Suite/bldg./apt. no.: / 16.60
Project nine s l
S TL & „ Footing drain (no. linear ft.: ) _ Page 2
Manufactured home utilities
Cross street/directions to job site: 111111 110.00
j �t • • e Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) all Page 2
Storm sewer (no. linear ft: ) _ Page 2
Subdivisiottl) h `t st- �;S alit M = (O
f � ��t I� - Z Lot no. & water service (no. linear ft.: ) P age 2
Tax map /parcel no.: C.o S.. B 3 Fixture or item
2DESCRIPTION OF . WORK{ Absorption valve 16.60
Backflow preventer -a Page 2 . 5 S
AP
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
•• : - • : P1tOPERlY"'.OW - , Drinking fountain
" ,' : Cf -a 16.60
Name: b r3.1 /J'�� S S y f # f Ejectors/sump 16 -60
/1� C�
Expansion tank • 16.60
A ddress: - /- J.s S cLt mil-, ( r_ f L1 U c,,c -�
City/StatrJZIP:L� �� , Fixture/sewer cap
16.60
C� () c Lt.l e G Q,Q `1 5 Floor drain/floor sink/hub
16.60
Phone: ( )
Fax:
( ) Garbage disposal 16.60
APLI , CUNT`e�CT PERSUIV : 16.60
P -
.. CAl!1T' V .. Hose bib
El sines name: Lard ..c 1/ .• �r-er .n J�- C__,
Ice maker 16.60
.1=71 Interceptor /greas trap
.4 Ci'_F� ^-f.0
Page Contact name: 2 -
Address: / �-) ( <✓ Medical gas (value. $ ) page 2
S LO rr m t
City/State/ZIP: 2 � 16.60
it - tm_ C.) k.-- ' `1 A2 C/' , L Roof drain (commercial) 16.60
Phone: (5c'3) e.G <' -? -�9-t/ - Sink/basin/lavatory
1 S Fax:: (��, 5 ) Y ,,1 - C• ' �/c �5 16.60 -
E -mail: Tub /shower /shower pan 16.60
. ' A • CO NTR - Urinal
CTOR 16.60
Business name L -L C {S(`lC
Water closet _
J {__ r gin Other: � n C - Water heater 16 60
�'1) /) i .s- al /w __
Address:
City/State/ZIP: a j,�-7 U�
!_ � 702 S _ j S 603) (G• 9 - 1 7U� Subtotal
Phone: ((56..3) (56..3) fL Fax: �i Minimum ermit fee $72.50 '!
- 07(D,�. Residential backilow minimum permit fee: 536.25 3[o , ,D.
CCB Lie.: 7 gO Plumbing Lic no.:
Plan review (25% of permit fee)
C~
Authored signs 66 L ' State surcharge (8% of permit fee) EMI
Print name: V � u� TOTAL PERMIT FEE 39 / S'
i Da - My , This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
+eW tat "etPermiulALMF- Pvmitnpp doe 12l03 *Fee methodology set by Tri-County Building Industry Service Board
440 . /02/cOM/WEH)
-
z - d eGT :so 170 20 daS
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: ,^ I ' ,• , ' 9 -4175
INSPECTION DIVISION Business Line: (50 • 4171 MST
� BUP
[
Received Date Requested —/ 7 AM 1O - PM BUP
Location J' 0 cd w Suite MEC
Contact Person Ph ( ) PLM 0760 q Ja ° C / 6 3
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 IL T 1- J "
Framing G
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Af
Susp'd Ceiling c p•-
Roof _t' ' `? ,1
L •'
Other: . r '
wr
Final '`
PASS PART FAIL � _ ®'
PLUMBING q �. _ =r - `
Post & Beam '
Under Slab % -...--y
Rough -In - :4
Water Service w r;�
f i;' ,err if'
Sanitary Sewer ,
Rain Drains -,
Catch Basin / Manhole _
Storm Drain
Shower Pan r%
Other: F.
PART FAIL '
,
HANICAL y
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA 0 4 / 70 (
Approach/Sidewalk Date �/ / Inspector \ ./ 12 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL