Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2004 -00012
DEVELOPMENT SERVICES DATE ISSUED: 1/15/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12370 SW WINTERVIEW DR PARCEL: 2S110BC -04100
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 012 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
4230 GALEWOOD ST [PLUMB] Permit Fee 1/15/04 $36.25
STE 100 [TAX] 8% State 1/15/04 $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
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: . 4,4 al
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next bu ne s day
Jan 14 04 04:OOp dan edmonds 503 - 692 -0768 p.l
. Niumbin P E tion FOR OFFICE USE ONLY
•%. Received I/ Plumbing
•
Date/By: Cp11 Permit No. czavy- 000 /
City of Tigard IJAN 1 4 2004 Planning Approval Sewer SW Hall Blvd. Plan Re Permit No.:
Tigard, Oregon 97223 Plan Review Other u �v1
. c .. Date/By:. Permit No.: m5ra0d3 �W
Phone: 503- 639 -4171 . • +r i . _ Post - Review Land Use
Internet: www.ci.tigarI.or.u s t N 'r` : = r ig Date/By:
Case No.:
24 - hour Inspection Request: 503 6' I + -� Contact J
Name/Method: Supplemental See Page 2 for
Su pplcmcntal Inff
ormation.
•
• ••; - TYPE OF WORK ..: • • ' ::•.- ' :. - r • FEE* SCHEDULE (fors spci:lil inforinitlon • ase checklist •: • • e.
New construction Demolition
Il
Description I Qty. I Ece(ca.) I Total
Addition/alteration/replacement i A Other: New;l & 2- family :dwellings '
s.`; CATEGORY.OF CONSTRUCTION„ .• ( I n cl u des:100 : .. ft fog erich utility connection).
El
I & 2- Family dwelling 0 Commercial/Industrial SFR (I) bath 249.20
• Accesso Buildin _ • Multi -Famil SFR (2) bath 3 99 . 00
0 Master Builder SFR (3) bath 399.00
■ Other: Each additional bath/kitchen 45.00
` .JOB SITE - INFORMATION and LOCATION' • . `... Fire sprinkler - sq. ft.:
Job site address: /2•3 70 Sub CD hvery iew D2 Page
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: 'Thor wood £ o /� DrywelUleach line/trench drain 16.60
Cross street/Directions to job site: Footing drain (no. linear R) Page 2
Q _ l) Manufactured home utilities 110.00
S 1.0 /3 ! . 61 4A- / , Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 7Yl0rti W oocL 1 Lot #: I ... Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: (D SS fj ' Water service (no. linear R. Q
D , Page 2
ESCRIPTION OF WORK" ... •'' ,. �Frieture.or Item'
(artfiSCq�LC3G��0I,[) �� L t; Absorption valve : ' 16.60
//�� Backflow preventer / Page 2 c a?. SS'
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
LT.. PROPERTY OWNER ' j:'( -] TENANT . • Drinking fountain 16.60
Name: lt Ejectors/sump 16.60
o - M csYrSS P iel - S Expansion tank 16.60
Address:4A 30 Stu 6,a•LL -e. d - Fixture/sewer cap 16.60
City/State/Zip: t-&-' C lues�6 G� 7p - Floor drain/floor sink/hub • 16.60
Phone: I Fax: Garbage disposal 16.60
APPLI,CANT Hose bib 16.60
-1
Hose - .', Ice maker
Name: El la) S Q.r/ pttJ 16.60
P Interceptor /grease trap 16.60
Address: / -O 0 St o rn JOriy RD Medical gas - value: S Pie 2 _
City /State /Zip: �i.taft.Ast'►l'�... O A. 930 (o Primer 16.60
Phone (0 161 - .9i IL Fax p3 ( 3 a.. U7/D Roof drain (commercial) 16.60
Sink/basin/lavatory
E-mail: 16.60
. Tub/shower /shower pan 16.60
:..,• .. "..:..:. _ -.: •CONTRACTOR•"• :'..: ": . ; ;.'•;:' •. Urinal 16.60
Business Name: I� l�dSC Q � y� - (, Water closet 16.60
Address: 1>D-00 w rn i �y le-b- Water heater 16.60
City/State /Zip : Q o , -Lk- - Other:
R- Q� O� D Other.
PhoneSa3 (tea - S.9 V S ( Fax (AA - 07/o • ; •'PJun b'ing•Perinit F.eees* .:- : X7:55 ,
CCB Lic. #: - 78Uy Plumb. Lic. #: Subtotal $ _
Authorized / ` / Minimum Permit Fee 572.50 $
Signatu -t-� /� ��t.► D atel• --� - o Residential Backflow Minimum Fee $36.25 3 � 0 • � - S
Ell
er) �" 1 � Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ e.? , 9,)
(Please print name) TOTAL PERMIT FEE S
Notice: All new This permit application expires if a permit is not obtained within •� o t Jr c
180 days after it has been accepted as complete.
riser diagram for commercial plan buildings require 2 acts of plans with Esmeri or
ra plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i : \Dsts\Permit Foru\PlmPermitApp.doc 01/03
r
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 , MST
����
C / BUP
Received `00 L 2 = ate Requested 2_/i 1 /c7 AM PM BUP
Location O (-Ltt) Suite MEC
Contact Person Q%4i1._ Ph ((V? Log Z S°9 5 C J )
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
Drywall ywal
Dywall 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
S- erPn
•
F e, PART FAIL
CHANICAL
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 /
ADA 1/
Approach/Sidewalk Date / Inspector / Ext
Other:
Final DO N I T REMOVE this Inspection record from the job site.
PASS PART FAIL