Permit r
CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2004 -00013
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DEVELOPMENT H B OR SERVICES 639 - DATE ISSUED: 1/15/04
SITE ADDRESS: 12435 SW WINTERVIEW DR PARCEL: 2S110BC -03300
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 004 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
P
RP /Backflow Preventer
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: . /j
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busines day
Jan 14 04 02:26p dan edmond 503 - 692 -0768 p.2
T,�
r � umbm Permit 41frief.1)1 R eceived FOR OFFICE USE 0 , A.. LY
Plumbing 4l eiD rut
` 14 ^00 " Date/By: Permit No.: 1
N
City of Tigard \ •' L '1 Date/By: Approval Sewer Permit IYate/BY; Permit No.:
13125 SW Hall Blvd. • Plan Review Other /►� z
Tigard, Oregon 97223 O V r t �. Date/By: • Perrin No. /n5To?OlJ.3 o d,5/ if
Phone: 503- 639 -4171 Fax: 503 - 598 - r ) - ' �1G ' 151 Post - Review Land Use
M �' < Date/By: Case No.:
Internet: www.ci.tigard.or.us • iJ.. e •J ii Contact luris.: 1l See Page 2 for
�
24 -hour Inspection Request: 503 -639 -4 175 Name/Method: Supplemental Information.
,' ••";'. - TYPE'OF WORK = '. .`' " .... FEE *. SCHEDULE •(forf'specikl'lnformatiod'ase checklISt) '
ew construction � Demolition Description Qty. 1 Fee(ea.) I Total
A ddition/alteration/replacement I Other: - New 1:; &' 2- family,.dwellings'
I__I
'. CATEGORY'_OF.CONSTRUCTION . .. ' .. (Incluaes:100 ft. for` each utility- connection) '
`'-' 1 & 2-Family dwelling Commercial/Industrial SFR () bath 249.20
3' g SFR (2) bath 350.00
Accesso Buildin Multi- Family SFR (3) bath . 399.00
_ ❑ Master Builder Other: Each additional bath/kitchen 45.00
. ' - JOB SITE INFORMATION and'LOCATION Fire sprinkler - sq. ft.: Page 2 .
Job site address: /0.443 S S CO Win fervruv Pt2... . .. • •:.. ;.:... : ; ' :, ..... . S,ite,JJtillthie :: ` 1. -
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name:771OYrl w xx.t CDT" Oil F Footing drain (no. linear drain 16.60 Page 2
Footing drain (no. liar ft.) Page
Cross street/Directions to job site: Manufactured home utilities 110.00
Si.l) W . M 1 , ` Manholes 16.60
(�'1/l N Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Storm sewer (no. linear ft.) Page 2
Subdivisiori: l�1QYr1 t t)C1C(fi Lot #: Water service (no. linear ft Page 2
Tax map /parcel #: .... - ,• ., . •
;! ;DESCRIPTION OF�W.ORK -' -, .• ' ; ". Flxture:ot °Item
Absorption valve 16.60
LL1 rUtS Cp C- *iGiCIC{7012.) Ci.e,L) / C.2> Backflow preventer / _ Page 2 a'J_ SS
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
:PROPERTY OWNER ' . ' • HD :TENANT - '' . ' • • .. Ejectors/sump 16.60
Name: p a y , M (Pr 1 S ( Pk- l kYnc Expansion tank 16.60
Address:4 -A 30 Su,t) Get- £44..,uo0 CC' Fixture/sewer cap 16.60
City /State/Zip: La -'Ice asp 6 CI -U3 Floor drain /floor sink/hub • 16.60
Garbage disposal 16.60 _
Phone: Fax: Hose bib 16.60
.APPL-ICANT • • ':. - ' t,CONT•ACT- PERSON - :5 :.`• Ice maker 16.60
Name: �� ..1 er, Spar C) Interceptor /grease trap 16.60
Address: I..)-0 0 S.W Yri •11Mt� RD Medical gas - value: $ Page 2
City /State /Zip: - 1,t.& O I fl. O 12 910 (o a_. Primer 16.60
Roof drain (commercial) 16.60
PhoneSo3 (ocia- - Sei %IS 1 Fax :563 (o'3 a.- 0710 g Sink/basin/lavatory 16.60
E -mail: . Tub /shower /shower pan 16.60
.. ' • •• :CONTRACTOR:. ., - ... . .. Urinal 16.60
Business Name: L4 r4.f O rC4 Water closet 16.60
- l�` � Z � I ' Water heater 16.60
Address: 1>D-00 $1...0 r' n 1.. i rt4 Yen. Other:
City/State /Zip:maLto -t.►ti ` l2. WIo(aa Other.
PhoneSb3 (AI- S9 4, 1 S Fax` )3 (old - ()Tog • . . : . • `•Plut bingRermlr'Fees *• `.. •7;S`5 -'' •
CCB Lic. #: "78Ut --I Plumb. Lic. #: Subtotal S
Minimum Permit Fee $72.50 $
Authorized 3( p . �S •
Si ature
��� �� Patel ✓ ( � � R esi dential Backtlow Minimum Fee $36.25
Plan Review (25% of Permit Fee) S
Eli en q /a v3 State Surcharge (8% of Permit Fee) S a , '
r (Please print name) TOTAL PERMIT FEE _ S .:R9. / S
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
180 days after it has been accepted us complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i:Wsts\Permit Forms\PlmPermitApp.doc 01/03 .
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
�/ BUP
Received !/Z 7� � Date Reque ed 3 ' / 5 —0 4 AM PM BUP
Location .1 Z 4/3 5 ...Gi ,l Suite L-f" MEC
Contact Person Ph (_622) e 7- ( - .0()/ 3
Contractor_ Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
/
Foundation Access: / 1 a ,d ' " p 1 c -� -
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear /�� ` / ' 1 S (�
Framing �E.J Ll
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 111
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower ;L
Other: ,
Fin..
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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA / �
Approach/Sidewalk Date TSJ 8 Inspector � �V Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL