Permit CITY OF TIGARD
PLUMBING PERMIT
4. DEVELOPMENT SERVICES PERMIT #: PLM2004 -00297
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004
SITE ADDRESS: 12049 SW WHISTLER'S LP PARCEL: 2S103CC -14700
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 094 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: Backflow preventer install.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST #100 [PLUMB] Permit Fee 6/29/2004 $36.25
LAKE OSWEGO, OR 97235 [TAX] 8% State Surcharl 6/29/2004 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 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: !%L . � _ .( Permittee Signature: / ,. /! / ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jun 25 04 10:22a dan edmonds 503 - 692 -0768 p.2
P, x,.•ng Perini k_4 ur∎ i i ' `' ?' _ .. • FOR / OFFICE USE O '\LL
'. u / % i/ Pat "/ 4 - 09 ' - (/� 2; Y
City of Tigard
JUN 2 5 '"" Sewer
1 006 Permit No.:
13I25 SW Hall Blvd. Other
Tigard. Oregon 97223 , : , Permit Nn.:
Phone: 503 - 639 -4171 Fax: 5 Land LRse
I
Internet: www.ci tigardot tls G i IVIS i , _ ,, ` ' i it ° , _,:, No_
24-hour Inspection Request 503- 639 -4175 ' Nanaglitethark
See Rage 2 for
'; :T.YYE'01<•WORif`- 'f:• .- �. :x• - : 1 _ .4 - .• : t..:.. - ;'I+ BBB_ 9. C1�D1�E-( toy'>fp�I1e!'os�oanse." j•
New construction Demolition - : Description I Q� j Vega.) I Total
Additiom/alberationhrplaoement Other: .' • : n ; Ne,+vtt & -1 tau'Iy '
'- CATF.CORYON = ::: -' . - ---. (`raei iOOft. roc- a ;` B y ::.,
OONS[RBCTION:. - _:;z ;r_ : <-_ ti j : -:.s.
1 & 2 - dwelling Commercial/Industrial SFR (1) bath 24920
SFR (Z) bath 35000
Q Accessory Building , Muhl-Family (3) bads 39900
El Master Builder • ❑ Other: Each addi6 oral 45.00
• ' • :JOB SlTRINFORMA.TION lurid 1<;oCA'IION' = Fite spritdder -
site address: sq. age 2
Job s /a2oSfy sty ��`i�;sf� Len - .,..=::,••' :•:'• �= •t;,�..�� �': =:nit: ;s .-,:,.=!.• . ` - .. -
Suite #: 1 B1dgiApt i : .� ba sinfarea drain ; : 1b. .
Pmjec N ame :l.l� tni S f1 EYS L1 6t SL- �. L Le r 9 t i !?rywell/leacr fine/bench dram 1660
Footing drain (
Cross streetiDire�ons to job sites (no. linear R) Page Z
blamffactured borne utilities 110.00
Manholes 16.60
Lk..) 2 ( Rain drain connector 16.60
Sanitrny sewer (no. linear 13.) Page 2
Subdivision: t� F1'i .sif rn L !LG 6 z L I Lot #: '9 / ! Storm sewer (no. linear IL) Page 2
Tax map/parcel #: L 55.: 65 Water service(aa. linear It.) Page 2
=::DESCRIPT3ON- WORK:: 1 .a :. : •' • =:.'.r•': :: .:::,•: .:7r •ITiitt ufe o`r�_Itei .: : _ • .
LaneMCapG vaziGfou.) iI i LC2.) M1 � l ur 16.60
• � 1 � I P aget � a.z. ss-
Bac valve 16.60
Clothes 16.60
Dishwasher 16.60 •
l 'a,PROPERTY OWNR$ .5.- .. 1: []TENANT ;: .? :F ' fD1m� 16 60
Ejector/sump . Name: Dort )OlrisS._tf1e. i4tf lc� 16.60
Address:4430 .S.-u) -CB-ty00 Gtr 1660
� 16.60
City/ State /Zip: 1 . 04-1.1..e..56 C170.3S Floor drain/door sink/1mb 'i• 16.60
Phone: Fax: Garbajtedisposai - I 16.60
e . . • _ Hose bib 16.60
CONTACT t . pq • � . _ Ice maloer 16-60
Name: El j ar r -i o - _
... Inteaceprontnase trap 16.60
Address: I Sa o O -S.w rnL tMU .120 Medical gas - va1ue $ Page
City/Statep- - Tl.t.[LIjt t- � 0 1 (a a__. Primer Primer 16.60
rA
Phone to32. - 9 4 S S 1 FaxS53 b 3 a- 0762 - F� (man 16 16.60
E -mail:
Tublshowalabowctpnn 16.60
.:..._ . :i::.••:,. ,.31CON1TRAC7`OR:7..:-•.: -_ :o,:...-..,• . _... Urinal 16.60
Business Name: yd,SCCt O r1C�ir m t, Water close[ 16.60
Address: I a nr) t �1.g1mr y en_
Water 16.60
City /State/Zip. `$ g7:L _
Phones 6:4a - 59 I FaxS03 Q.461 - OiLv • '?,:'.. ' "'ci. ,:iP3aaatii PeihmitFees*= .
CCB Lie. #: - Mpg Plumb. Lic.#: Subtotal a ' ?. •S5 - -
Authorized Minimum Permit Fee $72 50 $
Sinn-5..-4LL J1L A- , D I) r L) i,/ Residential Baddlowv Mainz= Fe a 336.25 • � o - � S
G `i � tSpQr L 1 Plan Review (25 %orPeanit Fee) ' S
Same St udtarlte (tlrJ6 ofpe_ Fee) $ . 9 b
(Please print name) TOTAL PERMIT FEE $ ,19_ / '
Node= This permit application empires Ira permit is not obtained within A9 new ormroereial bantling require 2 sets of plans with isometric or
180 days after ft has been entepted as complete.
-
Tier (Sign= for plasm review-
-- 'Fee methodology set !by Tri-Connty Building Industry Service Board.
CITY OF TIGARD 24 -Hour
BUILDING. Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
•
` BUP
Received Date Requested 7 — �° AM PM BUP
Location J 01 L I c f C--J Suite MEC
Contact Person Ph ( ) 2- PLM eZ Gld (- 1.02.9 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING q4,05.60
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Par \ [3(, � R)
Other: /� • / —• R�
flazk 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: El Unable to inspect – no access
Fire Supply Line
ADA G-036 (� Q 1
Approach/Sidewalk Date Inspector VV ` Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL