Permit CITY TIGARD PLUMBING PERMIT
" 'i" DEVELOPMENT SERVICES PERMIT #: PLM2004 -00343
L �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - DATE ISSUED: 7/22/2004
SITE ADDRESS: 12078 SW WHISTLER'S LP PARCEL: 2S103CC -13300
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 080 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 installation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST #100 [TAX] 8% State Surcharp 7/22/2004 $2.90
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 7/22/2004 $36.25
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 692 - 5945
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: �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin day
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.,2uilding Fixtures ,e,
Plumbing Permit Applicati41 •
FOR OFFICE USE ONLY
City of Tigard
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v 4. Da ) 41P- P erm it N° •? ( ---\(\,..? ODt/ - 0 O 393
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13125 SW Hall Blvd., Tigard, OR 97223 < ' :-)
• lb' Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 ‘\0
Other Permit No.:
24- Hour Inspection Line: 503.639A175 'V „,,. ,.. i - 0 . :! Date/By:
t --....1-!1P• Date Ready/Ety: Orb 0 See Page 2 for
Internet www.ciligard.or.us
.A 2\ - - -.."' Istatifted/biethad:
1 Supplemental Information
. : : r 1 : '''.; .: :::::,-.. oziti..Z.i:ait-c,..,' , ' , i:..•:',;,:-.-A
_ ill New construction 0 Demolition For special Information use checklist.
Description i Qty. I Ea 1 Total
0 Addition/alteration/replacement 0 Other:
New I. 2-family dwellings (includes 100 ft. for each utility connection)
6 a3W-2".7:4ft.'t0:Y~Titalig"".-D..; - :1 4 4 .4V,V ,:" . i ' 4 41- ' SFR (1) bath I 24920
1,kand 2-family dwelling El Commercial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Fire sprinkler ( sq. ft.) I Page 2
, .! ' .,9...7•4111W:MX4S-414,M.72=2aMitk::;" : '^ ' ' . .7 1 4 1 1 Site utilities
Job site address: b,./.0 7 g S tu W h I s 1 / cixs. (.00 p Catch basin or area drain 16.60
City/State/ZIP: 7-j la,,te,/, 0 p,_ 9 ?..a.„3 Drywall, leach line, or trench drain 16.60
Suite/bldg./apt. no.: 1 Project name: (A) wrE L ,$),0 Footing drain (no. linear ft.:, ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
g LL) /Di Sr /4
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: cUlni &fies)s UJ al K. Ph ckse- a 1 Lot no.: RC)
Fixture or item
Tax map/parcel no.: ( lk p )2, S.
Absorption valve 16.60
:-:,?......:.,...;,.,...01;:.,:iirettl.Y.i<1.'.k-Pa-,Trs..-...-.,-.....};•.r.mr../,•;A=.v.-..t.es...,:,1-.• •6:::.; , - , ..' , .*.---‘4..g BacIdlow preventer ) Page 2 D.7 sl
Lecne i 1 --Ccapr., Irr; qa:17 071 hace fl au) a el) i cr ' , Backwater valv 16.60
Clothes washer 16.60
Dishwasher 16.60
16.60
• .: ,Is„...77:1-zzli_..74,177.27m.4 11,;:miy,:717. ., Drinking fountain
' .-" Ejectors/sump 16.60
Name: b 6)1 610 SS C i Havr e..s
Expansion tank 16.60
Address: '1 30 s u_, &e-,..1 e c4..) 0 04_, Fixture/sewer cap 16.60
Gity/State/ZIP:Lre- kc OS' w -clO of q7 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
„.•••••••■;.? , . •••• ,.......7p5CF091r24A74.- A!:2i . , , wi • •■■• a :v , • 2.1 1ttp:F7:,:d: r Hose bib 16.60
,.. .... ....4i.i..4.Y..-1‘,. °. " . 't..111thiliiii-lt., . ' - •• .-- .. . ,. :. k.r, . 4w. t. •;: v
Ice maker 16.60
Business nam e: Lana sette-c ozo r...,-)e._, Interceptor/grease trap 16.60
C.:ontact name: ell ,,,Sp a
Medical gas (value: $ ) Page 2
4ddress: J O() s._Lv r 1 twiy 120 Primer
16.60
7 .ity/StatrJZIP:-,V lit &t , OR_ , g 76; 0 - Roof drain (commercial) 16.60
16.60
'hone: (5‘ (.0 4 7c:;/ -- -S - 9C/5 I Fax: : (52 & Fa - 7&,..r" Sink/basin/lavatory
Tub/shower/shower pan 16.60
3-mail:
Urinal
16.60
1 ,= : :k;". s r! 'Y'lliriV3cf;4:.'ig: 7: - • . :41, , V; - ' - '61■EM'.. ' !if 4,V,A ... A '‘; 4 f-
_
.p Water closet ,,,,,- .;,.• -,..;•.,,,, oset 16.60
lexiness name: La./)d-Sea i 0-e., arr--90? Water heater 16.60
Lddress: / „ S I . 1) ni LLS-ini.L., gip Other:
Subtotal
:ity/State/ZIP: 7ztatiLe7n, * V71)(e•--
Minimum permit fee: $72.50
hone: (503 ) 6 .S I Fax 6;93 eel 9cs? "' 60 Residential backflow minimum permit fee: $36.25 3 (a.
!C53 Lie.: 7 K.) Plumbing Lic. no.: Plan review (25% of permit fee)
' State surcharge (B% of permit fee) a ,e-
.uthorized signa .......4419a4.4....e.443
.
TOTAL PERMIT FEE ' 39, ( .g
riot =1=8 - ii e4 9'2a1-?v-cc.) I Dat'W .)-altiti This permit application expires if a permit is not obtained within
ISO days after it has beta accepted as complete.
*Fee methodology Set 111/ Tri-enimtv Ririleiina Truilletry Rnvir• Rnerrl
2 • al
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lyle: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested o p r ig AM PM BUP
Location / 2. o 7 g �-(./ /1.L . O Q ) Suite MEC
Contact Person Ph ( ) PLM ROO 5 1-- al-3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: EL - / '
Crawl awl Drain F / ' /
Slab Inspection Notes: SIT �
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing R>'•
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 a
Otr
4jap 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: ❑ Unable to inspect — no access
Fire Supply Line
ADA $_ }
Approach/Sidewalk Date Inspector D /Cp r L `
(� ' V ' ,1VJ . • E Ext
Other:
Final DO NOT REMOVE this inspection ecord from the Job site.
PASS PART FAIL