Permit J - - I
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CITY TIGARD PLUMBING PERMIT
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DEVELOPMENT SERVICES PERMIT #: PLM2004 -00140
04 c 13125 SW Hall B lvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/2/04
SITE ADDRESS: 12365 SW WINTERVIEW DR PARCEL: 2S110BC -03600
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 007 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: Irrigation backflow.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES INC
4230 GALEWOOD ST #100 [PLUMB] Permit Fee 4/2/04 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchar! 4/2/04 $2.90
Total $39.15
Phone : 503- 387 -7538
•
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
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
Issued By: Permittee Signature: " ,,f2A,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Apr 02 04 08:13a dan edmonds 503 - 692 -0768 p.2
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] 'flu abing Permit . i . on . FOR OFrICF USE ONLY
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City of Tigard " �'� Planning oval Sevier
13125 SW Hall Blvd. ' ,- . �- oo� Plan Review � t No.:
Tigard, Oregon 97223 � �0
Ca P` • Parrot No.:
Phone: 503 Fax 5 9
� "8u 1 9 v \S \! ,w Post- Review Land Use
Internet www.ci.tigard.or.us G 1 : ;t.; '" Came No ntact 24 - hour Inspecti Request: 111194149 " '�� r, 11 { � � I ® See Page 2 for
,� Supplemental Information.
-' , • . •.• ..- :...:,,:.. : TYPE.OF• WORK '
' .� • .:.<..; : ;••,,'
New construction - .. •._ ..... ; ` FEE SCHEDDI: E - (Rir sfliifo'rniatlon:ose ctiet3dist)
Demolition Description - 1 Qty. 1 Fee(ea.) ] Total
8 _ , . _ I � Other •s • _ " -� •New 1- ds?r- faimibr.dweplags'
_; CATEGORYQF.CONSTRUCTION:..,1, ;:•;.. ; ^' ; .: : •(indudrs.100 lity coitn on '
1 & 2-Famil dwellin • - Commercial/Industrial 249 20
t�I�KK: CY:aA•�t11Ci .. v . SFR(2)bath
WI Multi - Famil SFR (3) bath 350.00
■ Master Builder • Other 3 .00
' :JOB SITl;'I(YFO �' additional bath/kitchen 45.00
RMATIONi•and LOCATION F
Job site address: / 23 (� S � W !J' ire sprinkler - sq. ft.: Page 2
Suite I BIdg./Apt#: etch basin/area drain ` ' S1t iltiGtbEs. _. : 6 -'
16.60
Project Name: '7 U) L.e3< 7 • . &eO e , Drywell/ieacit litrdtreoeh dram Page 2
Cross street/Directions to job site: Footing drain (no. linear It-) Page 2
�} 642- u �� j . Manufactured home utiiities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision:77) OTT) auvc CC. I Lot #: O 7 Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: , 5.5 a.$ Water service (no. linear ft Page 2
"::::DESCRIPTION OF.WORK • ' • F•= •'Ftitii:re or- t ; •
L Ltl 1dS C - C,iCIG{�t7f.1) GLC. i p, Absorption valve 16.60
Backflow preventer 1 Page 2 fir/.'
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
'S.PROPERTY..OWNER': ..1 0.171+1011".) :_ < -. <.- :: Drinking foutuain 16.60
Name: Q4Y1 n'1(TY'ISSiz4f e.1SS Ejtxtorslaump • 16.60
Address:9 -V.30 ..S .u.) &4-1_14,-30 o d, F Expansion
sewer 16.60
cap 16.60
City/State/Zip: U -'1�, OS.cue6 q Floor drainlfloor sink/hub • 16.60
Phone: Fax: Garbage disposal - 1 6.60
[y,APPLICANT ' :....
Hose 16.60
laCON CONTACT PERSON 16.60
Name:
El l S Interceptor/grease trap 16.60
Address: ! D•a•O o SW /119.citirt3 R.D Medical gas - value: S ' Page 2 -
City /State/Zip: -� n-
altar , 0 970 (o a-, Primer 16.60
Phone953 (o 4.i. - 59 y S'' F (o a- o7( g' Roof dram (comme,•cral) 16.60
S ' n
E -mail: i ' O �' 16.60
. " `;•, . - 'CONTRACTOR. - - ., -:. l °Wet/sbower pan 16.60
Business Name: o A ��; 16.60
_ Address: I D p a� V l m G W closet 16.60
Ca Water heater
s ) {'Y)1 �fring eb- 16.60 ,
City/ State/Zip: ult_o k M othe
Phone q� t7(n a. other (4a - S9 j S l Faxg)3 (o! . .......„-.---5,3-,-,....,,,,, _
r � - a rJlo�{ ' �= a >M::pMaiDiaR - -; ;27"..:5 �'.
CCB Lic. #: "78Uy Plumb. Lic. #: Subtotal 5
Authorized J .° Residential Baddlow Mini
, / Miaimurtt Permit Fee 57250 5
si �'p.r) _ v Date 14 1 "l . mum Fee S36.25 ' - a - S •
E ` l en kc' • ar _j_ �a'(E Plan Review (25% of Pemrit Fee) S
(Please print name) TOTAL S (8% of Permit Fee) s a . 96
Not ce: This permit application expires if a permit is not obtained witbio TOTAL PERMIT FEE 5 .� so / S c
181) days after it has been accepted as completes AR new commercial buildings require 2 sets orplaas with Isometric or
- riser diagram for plan review.
*Pee methodology set by Tri- County Bundling Industry -.
natty Service Board.