Permit IA - 1sr
C ITY OF T I CAA R D PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00182
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/23/2004
SITE ADDRESS: 12076 SW WHISTLER'S LP PARCEL: 2S103CC -WW279
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 079 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: Residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES INC [PLUMB] Permit Fee 4/23/2004 $36.25
4240 GALEWOOD ST #100
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 4/23/2004 $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 =NT.. - 4 /I Permittee Signature: yl () rc rL-v
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
5 0 3 - 6 9 2 - 0 7 6 8 p . 2
dan edmonds
Apr 22 04 09: 44a
Pitunbing Permit Application
Received , / FOR OFFICE USE ONLY
Plumbin
-
Date/By: 7 »10( Permit No.: atiollet - /8 .1)--
In) F ;:: -- , .
Planning Approval Sewer
City of Tigard -F -- - '-- -
Date/By: Permit No.: .
13 125 SW Hall Blvd.
Plan Review Other
205
Tigard, Oregon 97223 . - ( - Date/By. Permit No.:
Phone: 503-639-4171 Fax: 503-598;1960 , ,...,, ,,_.., .. i - Post-Review Land Use
t,\
Date/By: Case No.:
Internet: www.citigarcLorCUS: V 1 / 4 -• •-• • '' '..,.,--•.,..,-) 1 :14: 1- 41(
Contact Jima.: el See Page 2 for
24-hour Inspection ReqUiik::.503439: '' '''''' -"" Name/Method: I Supplemental Information.
Hs- -Oct) 12-;
-... : :..-....- ' TYPE OF WORK - - .-.. .-:' '-'1' ‘.- . ' - , : • - , 'FEE*,SCHEDULE (for special inforination use Checklist)
• NI New construction a Demolition Description I Qty. I Fee(ea.) I Total
14 6 ' f • • .11,14411 • Other: .:'' =...-:, '; . -... . . ..,New .1...&24aMilydwellings
eaCh'utility'conoc
100 ft.
'• .- - ""...-- " -.Ouch 6i1 - i:tiotii. •• • . . - . .
-.: CATEGORYOF CONSTRUCTION .-:,-.::'..: .-'.. : '. - ' ' - '
SFR (1) bath 249.20
IIM 1 & 2 dwellin: M Commercial/Industrial
SFR (2) bath 350.00
att1=11' B ii , all $ Multi
SFR (3) bath 399.00
El Master Builder a Other: Each additional badr/lcitchen
• 'JOB SITE INFORMATION and LOCATION .L:. l' .... ' ' Fire sprinkler - sq. ft: Page 2
Job site address: A 0 t .' Wit; _. •' -e s to 4 :a --, .:: , ,%. :`,.:',..,: c - '...., ' SiteUtiliti es: : ' . 1;
Suite #: Bld: JA . t#: Catch brain/area drain 16.60
Drywell/leach line/trench drain 16.60
Pro'ect Name: 1,1)11' 's Wakk_i - UT
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site:
Manufactured home utilities 110.00
.c.4..1-) / c)- / g---/ 4-u1 __, Manholes
16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision ; s • Cr • 1 :T..1 Lot #: '7' Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax ma ./ • arcel #: l S ... .
- - , - - .DESCRIPTION OF WORK • ,.; - .. '-- ' '••• " 2 ' . -
Absorption valve
16.60
Laildg C a e_. ::, • cielt2) Gi.e_A- z .e) Bad flow preventer / Page 2
Backvrater valve 16.60
Clothes washer
16.60
Dishwasher
16.60
Drinking fountain 16.60
hr. ' ROPERTYOWNEW ' - ' 11 TENANT: • ' - ' - -- ' '''-' ' Ejectors/sump 16.60
Name: Day, 1 . I.S. ' a, ■.S Expansion tank
16.60
Address: A A30 Su.) &z.1 a.) Fixture/sewer cap
16.60
Ci /State/Zi , : (0 6 " - g7/ Floor drain/floor sink/hub • 16.60
Crarbage disposal . 16.60
Phone: Fax:
Hose bib
16.60
IllanlalaMINIIIIIMMEE'i.CONTACT,PERSON • 7.7.:(;'• Ice maker
16.60
Name: El I oi ar
Interceptor/grease trap 16.60
Address: i ..).04:3 CiA) rn ion RD Medical gas - value: S Page 2
Primer
16.60
Ci /State./Zi • : TuAtti-1 0 A. 970 G a-
Roof drain (commercial) 16.60
Phone Sb3 Lo 32, - $ 45 Fax SO1 tog a.- 076 g Sink/basin/lavatory 16.60
E-mail:
. Tub/shower/shower pan 16.60
- . ' . ..: CONTRACTOR • ::- --- . :" -; -:::-; '''..... '"..... Urinal
16.60
Business Name: Lo. .a . OM /TV\ . ' Water closet
16.60
Ir Water heater
16.60
Address: ED-D-00 - other
Ci /State/Zis:-Mta_lbsuNk- 4 ft- • 70(0a- Other:
•
PhoneStz &R. - SzbiS Faxg23 t.e9c1 - O 4 .::- -- - -:.., '." - --,-. Plumbin: Perinit Fees!. ', ' e2 , '
CCB Lie. #: - 7(1)(4 Plumb. Lic.#: Subtotal $
Minimum Permit Fee S72.50 S
Authorized d , / , _,
Signature-C- ) a-4../Lap Date:- el - 2?" - 41 Residential Backflow Minimum Fee S36.25 36 . aS -
_
Plan Review (25% of Permit Fee) S
El I en vs
State S • : e 8% of Permit Fee S e2 i
(Please print name)
TOTAL PERMIT FEE S 39. is
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require2 sets of plans with isometric or
180 days after it has been accepted as complete.
riser diagram (or plan 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 5 7/ -6 ) AM PM BUP
Location / 2-6 7 �Q /6 � u2 o ,c.4 4 Suite
MEC
Contact Person I� -r2 Ph ( ) e 1 ? – PLM�� C g
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 P /�
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pj�n 1 -
•� er:
• S PART FAIL
C HANICAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date f Inspector , / `DY��1 Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL