Permit w
y CITY OF TIGARD
PLUMBING PERMIT
r4, DEVELOPMENT SERVICES PERMIT #: PLM2004 -00376
-. J II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 3 9 -4171 DATE ISSUED: 8/19/2004
SITE ADDRESS: 12420 SW WINTERVIEW DR PARCEL: 2S110BC -04300
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 014 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: Installation of residential backflow prevention device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 8/19/2004 $36.25
STE 100 [TAX] 8% State Surchan 8/19/2004 $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- 9.
Issu d By: , �1i I■ , 0 I •
S' 4 I Permittee Signatur @� / t� -�--�
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.
Building fixtures Rg u'VE®
Plumbing Permit Ap>kflf FOR OFFICE USE ONLY
City of Tigard AUG 19 2004 r : $ l I _' _ Pe No.: , )4, 4 0 - 00
t 3125 SW Hall Blvd., Tigard, OR 97223 plan Review
Phone: 503.639.4171 Fax: 503.598.l96 c -: Y � +., l �wgy, Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ITY OF TIGARD I Date «mad �g I 121 See Page 2 for
Internet: www.ci.tigard_or.us BUILDING DIVISI. NotiSed/Method: / /a. Supplemental Information
• , .. :•i ti i VOK
V e ,' ^c. - .` •FEE• SCHEDULE
N New construction ❑ Demolition For special Information use checklist.
Description I Qty. I Es. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
J •
; , ,;.:CATEG'$k':QP O1Ui' 10 • - ' SFR (I) bath 249.20
1 - and 2- family dwelling ' OR T ❑ Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00 '
❑ Accessory building ❑ Multi- family
Each additional bath/lcitchen 45.00
❑ Master builder ❑Other: Fire sprinkler L_ sq. ft.) Page 2
• . -� .. JOB. Sq'E TIO *iI D;LOl�i4TIONV'''�� Site utilities
. -z
Job site address: JA'/AO S-u) W /f) - f - e - vfeu) be'1 u 6 Catch basin or area drain 16.60
City/State/ZIP: Ti letteL Cie_ g 7 3-03 Drywell, leach line, or trench drain 16.60 I _
Suite/bldg. /apt no.: t I Project name: Footing drain (no. linear ft.: J Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 16.60
Manholes
Cik) / ?I #11) -6 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: __) Page 2
Subdivision:' fl- fin W 00 a- I Lot no.:' �- Water service (no. linear ft.: ) I Page 2
S S 8 S.
Fixture or item
Tax map/parcel no.:
'''...T''-.," Absorption valve 16.60 •
. ". . ..- , . , . - r 4 : 014'!` WORIS e .9 ;` _. - • • • -, ; Backflow preventer / Page 2 e27. SS. • L �
X 44 SC eLpe, i rr/ / G (J-ri heL / I ao ciev i e 4- Backwater valve 16.60
+/ Clothes washer 16.60
Dishwasher 16.60 _
t 7 ._ S : - Drinking fountain I I 16.60
P10tE41 W �QW0 + •- - .pp , - . •,t 0t/ , ••:'r 16.60
:' � ,. :1. , i ., , l - "+ .. ff -T "'f Ejectors/sump
Name: b e t rm-y I .s S e.. t # /-told) e...5 Expansion tank 16.60
Address: i- f vZ 3 0 ,S Li) (af-( t-() o oct Fixture/sewer cap 16.60
City/State21P:L(L /< c 0 S (.0 •CQcj 0I&, G/ 70.3 S Floor drain/floor sink/hub 16.60
Phone: ( ) 1 Fax: ( ) Garbage disposal 16.60
,.� :+� ,:(. :�I, 1 r +. • Hose bib 16.60
:... ''� a r .' .. E 3 . N c.. Ice maker 16.60
Business name: Lama $ ear <, O/'CC' C'/1 ./ C. interceptor /grease trap 16.60 _
Contact name: El / en S f' ar"- .) Medical gas (value: S ) Page 2
Address: / D-00 ..(J) rnvS -11wj 2) Primer 16.60
City/State/ZIP: -pJJO &h . G- ` 7 7c C Roof drain (commercial) 16.60
3) (G ' -.S% /S I (503) (✓ V l ')&S Sink/basin / lavatory 16.60
Phone: t �.' Fax :: - G
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60 •- .'CONTIitACf OR ` :,.' • . •' Water closet 16.60
Business name:LanaS(± .L are -9C/1 'on c Water heater 16.60
Address: r -a-oo S /0 rn� /i n. R13 Other:
Subtotal
City/State/ZIP: 772/4 7n, QQ 70(10 1.- Minimum permit fee:
Phone: (50.3) fpQ S' S Fax: (5C3) (09.2 - 07 gs Residential backflow minimum permit f 536.25 3 .. o . S
CCB Lic.: 7 kU Plumbing Lic. no.: Plan review (25% of pentltfl
State surcharge (8% of permit fee) .j. 90
Authorized signs , G Leif 1 TOTAL PERMIT FEE 3 9 , S
Print name // �� Da • . l £ 011 This permit application expires if a permit Is not obtained within
`s1� 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
2 ' - e60 =80 .1 6i 2nd
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (5 75
INSPECTION DIVISION Business Line: ( ) 1 MST
J, � BUP
Received • Date equested AM PM BUP
Location >2)41146 1A-c, .D Suite MEC
Contact Person Ph ( ) PLM c2co Lf -663 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
lnt Sheath/Shear Sheath/Shear C
Int
Framing --
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: /IP
Final
PASS PART FAIL •
PLUMBING k
Post & Beam F'
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ov er:
t , 4i or
PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final o 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 ,� f I Inspector V Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL