Permit Sy , iw
j•■■, CITY OF TIGARD
PLUMBING PERMIT
r DEVELOPMENT SERVICES PERMIT #: PLM2005 -00190
s '�J II DATE ISSUED: 5/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S110BC -10100
SITE ADDRESS: 12498 SW WINTERVIEW DR ZONING: R -7
SUBDIVISION: THORNWOOD PARTITION LOT: 002 JURISDICTION: TIG
Project Description: Backflow device.
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
Owner: FEES
DON MORISSETTE HOMES
4230 GALEWOOD ST STE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 5/4/2005 $36.25
[TAX] 8% State Surcha 5/4/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone : 503- 692 -5945
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: . 7<.
V$
Call 503- 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• Building Fixtures
Fl Plumbing Permit ApphcibRi ►/ ll FOR
OFFICE USE ONLY
City of Tigard p t�ce;,ed
13125 SW Hall Blvd., Tigard, OR 97223 HAY 04 2005 Date/By. S_ '/ - OS Permit No ?'l� �. (//V� ?/II\J 45Da/ 9 /�
Phone: 503.639.4171 Fax: 503.598.1960 y , ; I , ; N Plait elB�y iew [/ V
24- Hour Inspection Line: 503.639.41 5'
Other Permit No.
Internet www.ci.tigard.or.ua r.
��
r OF TIG ' I" Date Ready/By: tutu ®See Pace 2 for
' g w r , - ' ` 7� r Notified/Method: Supplemental Information
•
' • IOSY FEE". 'SCHEDULE
• fqNew construction ❑ Demolition For special information use checklist
Description
❑ Addition /alteration/replacement 0 Other: Qty. Ea. ) Total --
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATE 3ORY OF ••CONSTRUCTION SFR (1) bath 249.20
■ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/ldtchen 45 00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
. ' 1 JOB iFE,INF LOCATIOi
Site utilities
Job site address: /Q / 9 ( ut.) w L /1 k, 444.) • , , Catch basin or area drain 16.60
City/State/ZIP: 7 / q � 0 y • 7 L q Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt_ no.: ! I Project name: Thor. Pta.e Footing dram (no. linear ft.: _� Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60
S CL) B 0_11 M TT) X,1) Rain drain connector
16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.• ) Page 2
Subdivision: ill. cry )1.0_3006C. PLviG -G2 ,./..., I Lot no.: Water service (no. linear ft • ) Page 2
Tax map/parcel no.: Co SS ' 8 Fixture or Item
Absorption valve 16.60
• ' 'DESCRIPTION . .OF WORK
Backflow preventer / Page 2 a 7 , .SS"
La I7 SC irr/ C 7 [m a
,� 111V / Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16 60 • P2t{SR)ERFT,Y QI�i/IYF'8 ` .• a ": ❑: " .N Drinking fountain 16.60
Name: Dart fllOYI SS t° • -i f. -k,- es Expansintr>n 16.60
Address: 1 .-/Q 30 S f U ( > Expansion tank 16.60
e ' L �� 0 a� Fixture/sewer cap 16.60
City/State/ZIP ;L fr DEW . Ole. 4 7 -1 33 5 Floor drain/floor sink/hub 16.60
Phone: ( ) % F ax: ( ) Garbage disposal 16.60
`RI:ICAl!IT :C U}V'CAC F PERSON Hose bib 16.60
Business name: Li a S et ,�-e OY an .ZtI C__, a Ine maker 1 6.60
`"7' Interceptor/grease trap ] 6.60
Contact name: El J S ^ arr. ) Page Medical gas (value: $ e 2
/-
Address: / - }p Q SW rn VS-' y Primer 16.60
City/State/ZIP:- Q-t ut, / o2 , 70 C Roof drain (commercial) 16.60
Phone: (503) to 9 - S9(4S' I Fax: : (.5 62 Fa - 0 76,.:`i Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
Unnal 16.60
- : i' - : C aNtRACTOR . •
• • r Water closet 16.60
Business name: / ,� `/ t
/,., � 1�(.•s� L ��� ��G Walerheater 16.60
Address: f aypp S w M ysiL IUD Other:
City/State/ZIP: JD� Subtotal
/ Minimum permit fee. $72.50
Phone: 5C3) (OQa 5 6
AS" Fax: 6 9Q - Q7(, e Residential backflow minimum permit fee: $36 25 c3 b - tom;
CCB Lic.: 7 KU Ci Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sigma State surcharge (8% of permit fee) . 9G
TOTAL PERMIT FEE 3 9, 7S
Print name• e 1/ � Dat•
� I �� 4410 ,r I Tbts permit application expires it a permit Is not obtained within
180 days after It has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1 ABulding1PerrnilsW1 -14F•Pennitgpp. do 12/03 440.4616x(10 /02/COM/WEB)
2'd B9L.0- 269 -EOS Ua i i3 e6EcII SO b0 FeW
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200500190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/4/2005
Phone: (503) 639 -4171 .4mrrsi l4,��'11
Inspection Requests (24 Hrs.): (503) 639 -4175 ����
INSPECTION WORKSHEET FOR DATE: 5/18/2005 TIME: 7:16AM PAGE: 13
SITE ADDRESS: 12498 SW WINTER VIEW DR CLASS OF WORK:
SUBDIVISION: THORNWOOD PARTITION LOT #: 002 TYPE OF USE:
PROJECT NAME: THORNWOOD PARTITION
DESCRIPTION: Backflow device.
OWNER: DON MORISSETTE HOMES, PHONE #: 503.387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 5/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP/backf low preventer 007204 -01 503- 692 -5945 N
Corrections/Comments/Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / )10 Date: 7 • Phone #: (503) 718-