Permit CITY OF TIGARD
PLUMBING PERMIT
M A , DEVELOPMENT SERVICES PERMIT #: PLM2004 -00085
l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/26/04
SITE ADDRESS: 12395 SW WINTERVIEW DR PARCEL: 2S1106C -03500
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 006 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: Install irrigation backflow preventer.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 2/26/04 $36.25
STE 100 [TAX] 8% State 2/26/04 $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
Phone : 503 - 692 -5945 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 By: Permittee Signature: 6i Gi.12/2.14:„& a r/!2
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Feb 25 04 08:37a dan edmonds 5 0 3 - 6 9 2 - 0 7 6 8 P . 1
r 1umbing Peri n FOR OFFICE USE ONLY
D i ffi v ; 1 1 : y p :y1) il 64 Zininr1:?4/27adi-/
• City of Tigard Planning
Datenty: Sewer
Permit No.:
13125 SW Ball Blvd. FEB 2 5 2004 Plan Review Other
Tigard, Oregon 97223 Date/BY:. Permit No.:
Phone: 503-639-4171 Fax: 61/3 B ,... . Post-Review Land Use
I ?" Date/By: ' Case No.:
Internet: www.citigard.or.ufBUILDING DIVIS :;i 1 ! contac t •
...r.: I EI See Page 2 for
24-hour Inspection Request 503-639-4175 - - Name/Method: I Supplemental information.
TYPE OF WORK - : "!..:•• • - •,,:' - : 1- 1: - :'•'.c:'''-'j! . ., ::.., : :::•:•••• 'FERfiCHF.DULE'(for*Piebt frifiiiiiiiidon.iiieifieekliirt) :' :,,•
New construction Demolition Descriptim I Qty. j Fee(ea.) I Total
Addition/alteration/replacement A Other ::::::, 3..j.lqiiiii&:Z;faiiiiiyAigings :,,.. • .:-; . )--. _:.• ' -- . •
• '. • • - •••••::..
CATEGORY OF CONSTRLICTION;;;;0:::!;...:214..-. '''' ' ''''''''' 2.(-mei Milt. fmtial utility mnecibn) '''''. . ' • ' - ' - " '
SFR (1) bath 249.20
1 & 2-Family dwelling Commerc
IIII ial/Industrial SFR (2) bath
ccessory Building , 0 Multi-Family SFR (3) bath 1 350.00
399.00
0 Master Builder ' 0 Other . Each additional bath/kitchen 45.00
JOB SITE WIFORMATION•suidEOCATIONr: :':::: -- Fire sprinkler - sq. ft: Page 2
Job site address: 4.2.395 $W (2,14jervi uo h i !i.e., 4 5::-'.. ,--1 .:.s:&;)'Y4: , .)::;:-- - : , ,-;.-4.4-',‘•:: Skithilities:::''s ; • . - .:;:l..-- :-• '',., - -
Suite #: 1 BldgJApt#: Catch basin/area drain 16.60
Dm/eV/leach line/trench drain 16.60
Project Name: Thor nt,o 0 ott... LOT 0 Go Footing drain (no. linear R) Page 2
Cross street/Directions to job site:
Manufactured home utilities 110.00
&w 6 a 1 1 I'Yxr N 12-0 Manholes
Rain drairiconnector 16.60
-
Sanitary sewer (no. linear ft) Page 2
Subdivision: Tho r n a) 00a- I Lot #: 00 storm sewer (no. linear ft.) Page 2
Tax map/parcel #: Co f g 13i," water service (no. linear ft) _ Page 2
' ': - •!'-•:•,• z - , :i '''nxiiir e •'","--:- .'" ' " 7:I ' • " - '-''''''-
',.'"•.. •:.'• .. •,. : • : 1-, DESCRIPTION-OF.WORK • •-• - -, I = T.:.•: - `':'' ' " ' ' •- ''''' - • • " ' - - -- - ''' - : - - • •
Absorption valve . 16.60 '
L.GliletS Cap G. gat-lc CI-0-) LCei Backficnv preventer / Page 2 .2.'7. ss"
Backwater valve 16.60
Clothes w 16.60
' Dishwasher 16.60
Drinking fountain 16.60
IOROPERTY ',' - '10 TENANT --)'-'•?`-"=•,.:-.•••..,=.- '::':: C• Ejectors/sump 16.60
Name: t)� I may144.01e. 146)11C.S Expansion tank , 16.60
Address:4A 34t) Zu3 . &4-/-.4.4.1..)00 a.> Fixture/sewer cap 16.60
City/State/Zip: 41.9-46e oshLiesio q7C.13.c Floor drain/floor sbildhub • 16.60
Garbage casposal . 16.60
Phone: Fax: Rose bib 16.60
APPLICANT, '•:- :;•::,'•::....::::.' ::•• riSICONTACI'l PIERSON :"":"..g.,':' Ice maker -
16.60
Name: el I cri Sparnru.D Interceptor/rease trap 16.60
Address: 1 D...0 0 CAA) rrijsiovx3 121) Medical gas - value: $ . Page 2
City/State/Zip: TL.taitaa Prilner 16.60 mk. 0 4. 9'7 o ( a -
Roof drain (commercial) 16.60
PhoneSce (090- - 59 4.5 I FaxSeS ioq a,- 0763 2 Sink/basin/lavatory .
16.60
E-mail: . Tub/showedshower pan
?•;;;`!:-'',-- • ' :•';',.:.:.,:::!..- ....,..••••::---; .?.?: CONTRACTOR : ",:•....;-;:;.!;, . Urinal 16.60
Business Name: ilLnafaxpe_ 0 rclinN me, Water closet . •16.60
Water heater 16.60
Address: l -D-Oc. .e..0 ryi 1 4.5(Ay et). Other:
_
CitY/State/ZiP:71.ta-to-f 'bit_ - 137 otaa_ Other:
•
Phonesba. (dj - SI2LiS Fax933 (p94 - OrlioX' ..:..r,.1:::7?..-1-5-;:y..-3 - : ,,- . - ;::Plniiitibigleriisitrees - ',-.. " :2 ':'• . '
CCB Lie. #: .7b 'Plumb. Lic.#: Subtotal S
Minimum Permit Fee S72-50 $ -,
Authorized ,,,_ , ,,
4 -e- 4 1 . _...49a/LA-a0 Dater[ 1 0 /4 Residential Backflow Min' imam Fee S36.25 .5 to - as
•
Kan Review (23% of Penult Fee) S
ET/ ef) ‘cpacr-er.43 State SurchaiRe (8% of Permit Fee) S .2 . 913
"(Please print name) TOTAL PERMIT FEE • S 39. / 5
Notice This permit applicadon empires if a permit is not obtained within M1 new commercial buildings require 2 sets of plans with Isontetric or
180 days after it has been accepted as complete. riser diagram for 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
/ 41/ BUP
YZ
Receive 3 • Date Requested 3 / .. 2- AM PM BUP
Location /2 3 9 5 (1 h 4,frA) t.QLL) Suite 47 MEC
Contact Person C e e Ph ( ) 1292- S 1ZS -x)00 'S
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
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P n
Oth �
in
A S 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 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL