Permit C ITY OF TIGARD PLUMBING PERMIT
A. DEVELOPMENT SERVICES PERMIT #: P 21/200 -00279
II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/21/2004
SITE ADDRESS: 12084 SW WHISTLER'S LP PARCEL: 2S103CC -13600
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 083 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 [PLUMB] Permit Fee 6/21/2004 $36.25
4230 GALEWOOD ST #100
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 6/21/2004 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
REQUIRED INSPECTIONS
Phone : RP /Backflow Preventer
Final Inspection
Reg #:
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: '>- 7
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jun 17 04 03:01p dan edmonds 503-692-0768 p.2
; robing Permit � fcallwa rp FOR OFFICE USE ONLY
C� of s I r \ � �� , i V �
City T iga rd y°
Pl u ming 'r seer
13125 SW Hall Blvd. Permit No.:
Tigard. Oregon 97223 0 Review Penning=
Phone: 5 03_639-4171 Fax: 503 -598 OF' I ° A H Y ' > c Use
F m1,licview Lead Use Internee wwwati .us t3�JILD!I\!G:y -yl i may: • Case No.:
24 -hour In Request 503 -639 -4175 , erLod: isms
' el SaPa�e2[or
A ..-AA Information.
e •• - .•. ••-. ._ . *-1" - .:FELL .
w c = ■ ∎ Demolition �fai� - I we e t e•
• Other: __: < • ; f Qom: ] (�) rte
• Addition/alteration/rep = .
t • i .. - F • C.ATE CORYAF.COMPRQCITON :: ' i ' ' .- '• F •.' ; {io ,- �'� 0 L e � Y: _ _
111 I 111' . smc
249.20
`-.- . Buildin: ii Multi Farm (� �h 330.00
• Master Builder • Other_ SFR batb
Each 399.00
' ;JOB 5 1T8'IIV ORl%fAT[ON find IACAflOPi �_ : �':Y : =: ad ioaal 45.00
Job site address: /moo g / ,S1.L (.Uhi S1 - C1 C.Ze F =ae , 4:1:- , sy. 2 Page
Bld basiu/anea drain
Projebt Name :11) u) 1.: L Lk) r- 873 . line/bench 16
Cross street/Directions to job Site:
Footing (h 16-
�( � •• Page 2
" - / > f r 3 7- 4 , Manholes ! 1040
Rain drain convector 16.60 16.60
1060
•
Subdivision: U% i1 i sl 1 z rs �i; c� _ SAY sewer (im. linear 2.1 Page 2
T a x 1 - # : , S � � L + L o t #:83 S t o r m sewer (ma. l i n e a r !L) 2 • - - • .'DESCEmniQlli•ITF W vVa service �aa.:sear. Page
LL1 ndSCQ pL cicciOCL.) p :1-.-... lve: " . • tifie of ;Ytesm' • :. ; : _:: .
dW CF> 18ow 1660
Backwater valve ill
Clothes washer 16.60 16.60
Di; oPERTlf OWivER .. .. " z • x ;:� � . , 16.60
Name: pp� m �Y r y �� � � 16.60
SSlZ � Jk'W1c�S „ . 16.60
Address: - A 30 Std &t'-L ! u.00 F � cap 16 0 = •
Ci /StatelZ' 1: t,.oe
-Phone: ` ' • C17! r F7oord�n/IIoor 16:64
16.60
Fax: 16.60
� PQ iCONrACII Hose bar 16.60
Name: j trt , p 0 Ice maker
Address:J�oo d� 16.60
YYE , en m - yak= S 16.60 e 2
Phoae5a3 1660
E-mail: ( o9 — S t +Ls F ax o1 - o ?b I
� R d� ( 1660
•�"-.•••-:: ..' -•`-1 - `•'�Ni'RAC OR :: : •==e; . U sboa`apa° 16.
Business Name: �Y1LLf • OM C • � :: a.. : �. Water 16.60
Address: I >DA:3 o M1 + . a Water heater • 1111 16.60
Ci /Brat
• Other:
16.60
i :'�1AQ.Qo -# tr`.. • R._. ZU(fl pear -_
PhoneS'03 (EC - S$SIS Fax ol io
CO3 • Lic g pc j - '' `�'���_ � ` 1 `�K�` -
Lic. #: '7 Plumb. Lic.#: 7Pci u oral S
�::�.. : �.sS
Authc Subtotal
si — Datjop 7/ )q l Bay > Fee S72.50 $ -
�'`� QT/�,� PlaaRenew - . ofpe t Fee S
Node= This print rime) State ' - • : • ofP rmit Fee
180 days a8er been lra marina is not obtained *Ridge AB new 2a TOTAL PER'Mrr FEE S 39_ / S
-
orgdans
--
"Fen welbodorog ,, by r ty BuHreng Industry Service Board.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 63 5 MST
INSPECTION DIVISION Business Line: (503) 6 1
BUP
Received Date Requested _( AM PM BUP
Location Suite MEC
Contact Person Ph ( ) y ST' c/,- PLM �DD S ' Do� Z9
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 /�, - A
Framing le,r;• V ��'� -c--'c ��c S — cxx_S'S-e.Q •
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab C c
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Oth =• i
PART FAIL
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date o Inspector Ext
Other:
Final DO NOT R MOVE this inspection record from the job site.
PASS PART FAIL