Permit •
4 'CITY OF TIGARD PLUMBING PERMIT
I4, DEVELOPMENT SERVICES PERMIT #: PLM2004 -00508
Ail 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/8/2004
SITE ADDRESS: 12490 SW WINTERVIEW DR PARCEL: 2S110BC -08800
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 059 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 [PLUMB] Permit Fee 11/8/2004 $36.25
STE 100 GALEWOOD ST [TAX] 8% State Surchari 11/8/2004 $2.90
STE
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 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: i/ I
Call 639 -4175 by 7:00 P.M. for an inspection needed the next b , si'ess day
Ni,
Building Fixtures
0
Plumbing Permit A 14 FOR OFFICE USE ONLY
City of Tigard 10 Received 13125 SW Hall Blvd., Tigard, OR 97223 1, � kl a
-' . 'f i Date/By: Permit Nol e �
r -o� ;
Phone: 503.639.4171 Fax: 503.598.1960 !v 1k� Plan Review
`"' i \ y Other Permit No ��
24- Hour Inspection Line: 503.639.4175 �� ® ' r , l /'H�oT
Internet: www.ciligard.or.us 0 ' + D a t e Ready/By:
NotiRed/Method: furls
gar ` "' El See Page for
(,9,� Supplemental t Information
T YPE Q 4VOItK FEE` SCHEDULE
New construction ❑ Demolition For Special information use checklist
Description
❑ Addition/alteration/replacement ❑ Other:
QtY• Ea- Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
•
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
N1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( _ sq. ft.) Page 2
• • JOB. SITE INFORMATION .AND LOCATION -
� � Site utilities
Job site address:/c.../q0 G
a, qV d W WI n i cu.) h Catch basin or area drain 16.60 I
City/State/ZIP: r r ` j am o,e 7 7 t , / Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Thom wood_ Footing drain (no. linear ft.: ) Page 2
'h
Cross street/directions to job site: Manufactured home utilities 1 10.00
Ut) /Z„ , i( mil.) /I ,� Rands 16.60
(J W ���"�1. I��"J Rain drain connector 16.60
Sanitary sewer (no linear ft.: ) Page 2
Storm sewer (no. linear ft : ) Page 2
Subdivision: ' o/n ll.t()OGL. (or' s9 I Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: i.D ss 2).s-- Fixture or item
•
Absorption valve 16.60
DESCRIPTION OF WORK . '
Backflow preventer / Page 2 .7 _ SS
Lind Sc.: /rr/ CL/7 (3)1 0 axe UL;,i - / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• ,PROPERTY: • QWNER , , • ,1 , Drinking fountain 16.60
:TENANT
Ejectors/sump 16 60
Name: D0 pY)GYl S s . /- # /f awl rvS
Address: L 3 p S w �e (C l'.CD O 6C Expansion tank 16.60
-L. Fixture/sewer cap 16.60 I
City/State/ZIP:La_/ e, OS w .( 70 aA G/ "7 0.3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
APPLICANT _ Hose bib
CONTACT PERSON 1660
Business name: Lam n a S �l?O -e, or. Ice maker 16.60
��, ..E.1.1 C' Interceptor /grease trap 16.60
Contact name: , /I Cu S n er _ Medical gas (value: $ ) Page 2
2•a -DU . -f I lI g
Address: � n1y�- �lSYlt,/ � Prim 16.60
-
City/State/ZIP: -(,ij a- jam , G 2 , J c 70 /„ Roof drain (commercial) 16.60
-
Phone: (503) (G %t -- S 9(•/S Fax:: (52'3) (, QQ _ 0 767c Sink/basin/tavatory 16.60
E -mail: Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet •
16.60
Business name:L, jse,„ ^ 0-rev: or) kin, ..../..? G Water heater • 16.60
Address: /,?--,D--,00 S IL' M� YT / Lry{ lVn, Other: -
City/State/ZIP: 7/14_6.24-)r-i„ *1 0R,. Ue Subtotal
Phone: ) Iota S / /� Minimum permit fee: $72.50
S- Fax: 603 (, 9 ) - tY7(0 8' Residential backflow minimum permit fee: $36 25 3' o - QS
CCB Lie.: 7 Plumbing Lit. no.: Plan review (25% of permit fee)
Authorized sigma State surcharge (8% of permit fee) .2 , 9 t'
�� TOTAL PERMIT FEE I, /S
Print name•`! ef) (� -r ' ` Daty P -CJ 1 This permit application e
%' K.J )!'- 0� �-1 p Pp ' expires if a permit is not obtained within 180 days after it has been accepted as complete.
i:�Bui *Fee methodology set by Tri-County Building Industry Service Board.
g+PermfulPf Permitgpp.doe 12/03 440-46 I 6T(Ionnicommaa)
a� - e8I :II bO .00 AO
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 175
INSPECTION DIVISION Business Line: (50 MST
BUP
Received Date Requested ��-- 1 (^ ( 7 AM PM BUP
Location / D CIJ�c y7/11. _c.t J Suite MEC
Contact Person Ph ( ) PLM ° ba y'Z So 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab i7 Inspection Notes: SIT
Post & Beam"
Shear Anch s
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 Pan
Other:
PART FAIL
V °9--
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El 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: 0 Unable to inspect — no access
Fire Supply Line
Y
Approach/Sidewalk Date I 1 CA / Inspector — Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL