Permit CITY TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2004 -00351
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/29/2004
SITE ADDRESS: 12054 SW WHISTLER'S LP PARCEL: 2S103CC -12100
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 068 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: Landscape irrigation backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES INC
4230 GALEWOOD STE 100 [PLUMB] Permit Fee 7/29/2004 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 7/29/2004 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 RP /Backflow Preventer
Final Inspection
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: _ _(/ __ Permittee Signature: QS
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Anne ' � ti � �di' ' '
FOR OFFICE USE ONLY
City of Tigard i`'' p,; 26P Reeeiyad 7 - I Permit No.. >L i
13125 SW Hall Blvd., Tigard, OR 97223" Daway : 720i U Js
Phone; 503.639.4171 Fax: 503.598.1960 Plan Review [/ J
24- Hour Inspection Line 503.639.41 vP Date/BY: Other Permit No.:
Internet: www.ci.ti 75 ° i :�`�' • Li t; ' � � �
'' � n �j ®Sea P
r e d.or.us
Notified/Method: �^. }� (l�Li ;'L DateReeady/Bod: lure: aCe2for
)f k L 1,0 a �,„„ � ,. •. �ti. Cr-�
• ". x ; 1 r t ~• ctig. ! Q : ' gkW�6 34 = -„ •?:'':{;'• • i T ta a' ,'� a : ' '7 y , 17 r a::. enta r
�, Supplem Ilnfo Non
❑ New construction a n, «,:�� _r g�Y,t.• , .' 't,E$�`; "isE k''
❑ Demolition For special information use checklist
0 Addition/alteration/replact ment Description j Qty. j Ea. Total
❑ Other:
: ..,.. dwellings each u )
:,R± ar t^tn a e x� `• N. : MI ; ,':e �' "L . <.. • New ew( ) b Emily dw gs (includes 100 ft. for utility connection
nay ,„ • al:: <<•;M < SFR ]
V. � •.: 249.20
i. 1 and 2 family dwelling 0 Commercial/industrial SFR (2) bath
350.00
❑ Accessory building ❑ Multi family SFR (3) bath 399.00
❑ Master builder O �� Each additional bath/kitchen 45.00
n '}' '° `' Fire sprinkler
. w'':f 4i ; , f f$ -y 1 i'r' u 111,4T:' � o". 'i a� 0 7 s , r utilities
( sq. ft) Page 2
! at7 S '` , �'.. , ': Site utllitles
Job site address; y Whi
City/State/ZIP: ��S L' a�� Catch basin or area drain
16.60
ZIP:
7/414.4.a..) 97 aa_3
OR. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt no.: I Project name: (U Footing drain (no. linear ft.: ) Page 2
LoT Co g
Cross street/directions to job site :> (t-/ ST iI v Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: (1i VIfi s -- Hers w al K, Tr- j Lot no (o 2 Water service (no. linear ft.: _ ) Page 2
Tax map /parcel no.: C .S_ as 8 5
Fixture or item
i , r L< M *`bk15 t A" `''O� QV" S: : < = :: _ Absorption valve 16.6
L ne!Se i .. . ' B ac kfl ow preventer / Page 7.SS-
f i Frr/ 9 f haac i / Q() 6( et); <,e- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
c.,-. +,S r•' r . .. , r • 7 ,� i ,. .y, :y Drinking
;r a �� r G, '? . llii !r . ; 3 ; ;;F . l °. D g founta 16.60 ■ Name: t Ejectors/sump 16.60
Zei Y)) /JYl s s t= Ai, // Dyi >v S
Address: /� Expansion tank 16.60
0�..3 U S LLS &t(! (- LI U Oct Fixture/sewer cap 16.60
City/State/ZIP :[ Ke D E w -c?G Off. 9 0 3 S Floor drain/floor sink/hub
16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
�, .e'i# A:: ", . - � f o' : e ` 'c Hose bib 16.60
Business name: �� e� U`i Ice maker 16.60
Contact name: J S Cn, �� G Interceptor /grease trap 16.60
P <<rr Medical gas (value: S ) Page 2
Address: , a; oo S-in m y c• I nry 20 Primer _
16.60
City/State/ZIP: - t'i t (,(t a..0. , G ‘ Y 70 Roof drain (corrtmercial) 16.60
Phone: (5J3) I � " C/ - I Fax: : (503) (, pi - 6 7 6,� Sink/basin/lavatory 16.60
E-mail: Tub/shower /shower pan 16.60
= ^:Ji` ='Z'',. `' :.Jl1 , 1 '.4i d0 ,,,,,�,44�,ay ; ..- )-_- : ; I , t •;r;:;. :•.. Urinal 16.60
„< �: { F 1 ' c :,A" . :i i:`r. = ',71•a Water Closet 16.60
B usiness neme lstAtiSe1 -� C. aj
Address: I / 0m .
� ,) C.: Water heater
f ?':D -t'>G Sp) nri - 16.60
f, (J�. Other:
My/State/ZIP: ' ,� 7n .J , Subtotal
'ho 6 r'3) ipYoZ -5-9-1S- I Fax: CO3) /, a Minimum permmt fee: S t
e07 •• 07O E' Residential backflow minimum •ermit fe• �0 - 0
=CB Lie.: 7 et:) Plumbing Lic. no.: Plan review (25% of permit fee)
kuthorized signs State surcharge (8% of permit fee) c2 _ 90 ..-■ 6./...4,,.4._,,Z.,0
'tint name `l TOTAL PERMIT FEE 9 / g
K Date -7 a /cti This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodoloav set by Tri- f.nnnry RI ilAmo inAnetry q.rvir. n,,..,1
a'd d8E :1O t.O sa Inc
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line:, (503) 639 -4175
''k MST
INSPECTION DIVISION Business Liner ° (503) 639 -4171
p BUP
Received Date Requested r 3 AM PM BUP
Location ( a'U S'1 1 CL) Suite MEC
Contact Person Ph ( ) PLM a00 Cf -663s (
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC Mill
Foundation Access:
Ftg Ftg Drain ELR i YAI
Crawl Drain 1 /� „
Slab Inspection Notes: SIT 40 ,
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing .----
Insulation
Drywall Nailing
Firewall 6 1
Fire Sprinkler
Fire Alarm
Susp'd Ceiling .
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab. •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain .
Shower Pan /2
Ot;r: Mir
in
41401 PART FAIL
M ANICAL
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 0 Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line ��
ADA
Approach/Sidewalk Dat �� Inspector L� Ext
Other:
Final DO NOT REMOVE this Inspection racer from the job site.
PASS PART FAIL