Permit 4 CITY OF TIGARD PLUMBING PERMIT
i4 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00470
..�J� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 10/11/2004
SITE ADDRESS: 12074 SW WHISTLER'S LP PARCEL: 2S103CC -13100
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 078 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 residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 10/11/2004 $36.25
STE 100 [TAX] 8% State Surcharl 10/11/2004 $2.90
LAKE OSWEGO, OR 97035 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 -01 I 0 ! I You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 .699.
Iss -d By: Permittee Signatu
Cal (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures �SV
Plumbing Permit Applil;,a tt�
FOR OFFICE USE ONLY
City Of Tigard �'� 10 � Received �� D ' , �� . � ��� �
13125 SW Hail Blvd., Tigard, OR 972 . b Dater• e !4/
Phone: 503 639.4171 Fax: 503.598.1960 \C"'/.21.,
-S . I 1
�^ : \ Plan Review
24 Hour Inspection Line: 503.639.4175 O� ' _ =" ' %'I 1'j ` Date Rea dy/By: Date Re Other Permit No.
Internet: www.Ci.tiga 4 P � - . . ady/By: /f fill See Page 2 for
� Notified/Method: / /• I Supplemental Information
P
FEE''SCHEDULE
IN ew construction ❑ Demolition For special information use checklist
❑ Addition/alteration/replacement Description I Qty. I Ea. 1 Total
❑ Other:
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
.. • , ., .4_,'.CA,T OB',f'ONSTBUCTXOIY _ . SFR (1) bath ` 249.20 I
N - and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45A0
❑ Master builder 0 Other
Fire sprinkler ( sq. ft.) Page 2
•r . . dO8. . S4*...,*, 011. VIAT OtA if' LtiCA,T[ON . r ' g
� J- te .�� � Sr: . Site utilities
Job site address: l ao 7 f-/ Q (,() VI Sly et - s uDof) - Catch basin or area drain
16.60
City/State/ZIP: TT q a l j 0
J l/ g 7 D- d-- 3 Drywell, leach hne, or trench dram 16 60
Footing
Suite /bldgJapt. no.: Project name w 7 p drain (no. linear f .: g
J tvhlst)er s wat -E r5 g C ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
S,l t ) ' 24 Manholes 16.60
�`� Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision :(». I SH t ' 1 t r•, p a� L T I Lot no C / Water service (no. linear ft.: ) Page 2
Tax map/parcel no.: lio G-S A S L l � Fixture or item • ' - 'DESCRIPT1rON OF WORK - Absorption valve 16.60
Backflow prevenler Page 2 2 rj
1— nel S[' ape, i i , 1 / (.. l f-i G71 hnxL2C1 ,,-/,,,,,), ♦ ,-, Backwater valve 16.60 5 S
I I Clothes washer 16.60
Dishwasher 16.60
PRbPERTY.�O : - ; : ( Drinking fountain 16.60
Name: b C i - n ~ S S L - ,L f HC C J _ 1 - ' Ex sump 16.60
Address: 4—I 3 L' ,:j Lt.) Expansion tank l 6.60
(4( e co 0 c; C'( Fixture/sewer cap 16.60
City/State/ZIP:/ .LX /< G Q L Li C %Ci Q y 7 o--3 5 Floor drain/floor sink/hub 16 60
Phone: ( ) Fax: ( ) Garbage disposal 16 60
. .. .. APPlLiCAbiT- " * " - :71' CONTACT PERSON Hose bib 1660
•
littsiness name: // �, _ • ' Ice maker 16.60
L O s /'1C -c, oreeic -n .T.:-,-.! Interceptor/grease
Contact name: %' .� r ! Se ma p 16.60
C - d - p 2TP O Medical gas (value: $ ) Page 2
Address: tat
f 2D-00 L S u) 11'1 v-c /. RD Primer 16.60
City/State/ZI'P:71W •hit. , GO_ , -) i '7/". � Roofdrain(commercial) 16.60
Phone: (5r3) ( ' /s' l Fax: : (5051 6' r - C' �le'��i Sink/basin/lavatory 16.60
E -mail: Tub/shower /shower pan 16.60
Urinal 16.60
. • '.. • , • .. CONTRACZfOR - : . , W clo�rt 16.60
•
Business name: nt.S(IeJ -e arrf r, C W ater heate
`// _ 16.60
Address: / ,,.....g.--00 h oc ,S (0 t -f (;1111 �0 z.-L_ / Omer
City/State/Z1P : (- -,0-,04. U 7U-- Subtotal
o
Phone: � �3) �Qa ��. f V (F Fax: �� 3) C9Qf /� /� ^^�� Minimum permit fee: $72.50
/ - 6747 g Residential backflow minimum permit fee: $36.25 3 (p - a S
CCB Lic.: �j(j Plumbing Lic. no.:
n Plan review (25% of permit fee)
Authorized stg na�/ / �, y State surcharge (8% of permit fee) . 9 C
Print name" � _ ✓ ` - �! ` ✓✓��� TOTAL PERMIT FEE '3 � � / S
1 i Dat..ipi j Pi , I This permit application expires if a permit is not obtained 's ithin
1 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Boaro.
it au 'ldmgWennnsWLMF- Pantitppp.doe 12/03 440-4616T(I0/021COM/WE9)
— 2 ' — d : 2 i t . 0 I I 10O
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received / Requested // AM PM BUP •
Location 1 �- U 7 (( /(� Suite MEC
Contact Person Ph ( ) PLM 69 0 L I --6,0 gZ4)
Contractor Ph ( ) SWR
•
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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: —
_
_v
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: f
og i- 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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line IV)
ADA �(
Approach/Sidewalk Date 0 ) - / /6 �C Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL