Permit 41, CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00431
,. I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/17/2004
SITE ADDRESS: 12053 SW WHISTLER'S LP PARCEL: 2S103CC -14500
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 092 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.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST., #100 [PLUMB] Permit Fee 9/17/2004 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 9/17/2004 $2.90
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 -6 •
Issued By: 1 / /l ' j ' Permittee Signatu : ,_.. 14/
Call (5: 639 -4175 by 7:00 P.M. for an inspection nee.ed the next business day
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Plumbing Permit Appiicatiogp 1 6 200
FOR OFFICE USE ONLY
City of Tigard , T , t, Received (
13125 SW Hall Blvd., Tigard, OR 97223 CO OF 1pp SO Date/By: � / V /pf Pent No.: I�.vh t/_ l/3/
503.598.1 %O O% NU° 0 Plan Review
Phone: 503.639.4171 Fax `!
11 11 ,
Inspection line:: 503.639.4175 �V ' Dare/ Other Permit No.
24- Hour
Internet: www.ci.tigard•or.as rl? � I' Date Ready/By: Iwu I ® Page far
Notified/Method: //G
' V Supplemntal 2 tnrormation
''1YPE Q .: WORK : - , FEE* 'SCHEDULE
New construction 0 Demolition
For special information use checklist.
❑ Addition/alteration/replacement 0 Other: Description I Qty. Ea• Total
New 1 -2- family dwellings (includes 100 ft. for each utility connection)
„ •CATEGORY O : ('O,NST1tUC�'XON SFR (1) bath I
249.20
/a and 2 family dwelling ❑ Commercial/tndustsial SFR (2) bath
❑ Accessory building 350.00 —
❑ Multi - family SFR (3) bath 399.00
Master builder Other: Each additional bath/kitchen 45.00
+r - _JOB.' SIf�CS OF OR 1O S AL�1J LOCA1'IUN Fire sprinkler ( sq. ft) Page 2
Job site address: / 01-� S3 Su.) ', - � - site atilities
w in; st - tee - s cop Catch basin or area drain I 16.60
City/State/ZIP: T A /
� J � -a — U Q- 9 7 0_0..3 Drywell, leach line, or trench drain
1660 I
Suite/bldgJapt. no.: l Project name: whCS7ye, Gt.Yk.QdieZL 42 Footing drain (no. linear ft.: _ ) Page 2
Cross street/directions to job site: Manufactured home utilities I 10.00
5(A) I
2-1 �Q_,., , �. Manholes 16.60
t �/C Rain drain connector 16 60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisicfrk.) 1 i 5^ t7C.r'S l.L) Water (no. Q� - �� l L ot no.: W ( ) Page 2
Tax map/parcel no.: COSS as Fixture or item
- . DESCRIPTION- OF• WORK Absorption valve 16.60
r Backflow preventer I Page 2 a 7 -SS
� ")4 Se_: ape: i rr, Poch o/1 haze f cr,CI i,/v�, / e r' 1 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY= ,OWNER. ; , I•'.,F 4N I - Drinking fountain 16.60
Name: r r T y /�T f
Electors/sump 16.60
!)t!? dY )L,�l „� Y)'1 � J P
3 �� S co Expansio tank
16.60
Address:
&t. ( t_ E 0 0 OC'( Fixture/sewer cap 16.60
City/State/ZIP:L.C2_XX C% S t.ti C7 ()/2 l • --
y 7 � `s Floor drair✓tloorsink /hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 1660
a Hose bb
AYPI:ICANT • ' �COItTACT :PERSON.'. 16.60
Business name: lari a S C'1 e. Ci/ e � (� y� _n Ice maker 16.60
Contact name: ��f� J / Interceptor /grease trap 16.60
Medical gas (value: S ) Page 2
Address: / -p L; S 1 rn Li.S //Wei
I' ' J 12D Primer 16.60
City/State/ZIP: u ii r Cif . - 7C. Co Roof (commercial) V'� Rf di ( ) 16.60
c 3) &C/ — SC Sink/basin/lavat
/ys Fax: : ( f...2 - C' r � (c °,` we 1 6.60
Phone: (5
E -mail: Tub /shower /shower pan 16.60
Urinal 16.60
• • •• CONTRACTOR •.
Water closet 16.60
Business name:LI /0S r �„ JJ � 0 f -1�7r �� C Water heater
''`� I 16.60
Address: /,?-=)--00 ,S /0 fp t-(•Sf (,il�•Lf Other: 1
City/State/ZIP: ' ita_e,,4.71,1 CQ , 4706,:a - Subtotal
P4one3) �Ya �p Fax: Minimum permit fee: $72.50
7�g Fax: ) ep7�• v r ](p�' Residential backflow minimum permit fee: $36.25 3 ' ��
CCB Lic.: - 7 g(> Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized si -, p ` /E�� State surcharge (8% of permit fee) Z . 90
Print name � TOTAL PERMIT FEE 39 • t S
Da vR' r (0 /OL , This permit application expires If a permit is not obtained m Whin
180 days after it has been accepted as complete_
i:1Bw•IdinglPemiit5lPLMF_P maizA 'Fee methodology set by Tri -County Building Industry Service Board
pp.doe 12/03 440- r616r( IO/02JCoM/wEo)
Z . -� eSt. LO .170 9 T daS
CITY OFTIGARD 24- Holy -,.,_ 7 '
BUILDING Inspea41sine: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
•
Received Date ``Req ues ed , 9 ✓ ?- AM PM BUP
Location [ �'0 S W Suite MEC
Contact Person Ph ( ) PLM c ( Z
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
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other r
`ASS PART FAIL
MECHANICAL
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: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date � 23 I Dy Inspector � L 1j1I Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL