Permit CITY OF TIGARD PLUMBING PERMIT
l � DEVELOPMENT SERVICES PLUMBING
PLM2004 -00015
'll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/15/04
SITE ADDRESS: 12495 SW WINTERVIEW DR PARCEL: 2S1106C -03000
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 001 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 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: ill / z _.„.■ �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin - ss day
J: 14 04 02:19p dan edmonds 503- 692 -0768 p.2
FOR OFFICE USE ONLY
r • Ph mbing Permit A lication Received u - Plumbing
RE Date/By: �Tt Permit No aw ,/ - ODO /-S
Cl of Tigard Planning Approval Sewer
�J b Date/By: Permit No.:
13125 SW Hall Blvd. i 2004 Plan Review Other
Tigard, Oregon 97223 JAN 14 Date/By:. Permit No. :/� -�y107
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
CITY OF TI ' y� •; htL, �• Date/By: Case No.:
Internet: www.ci.tigard.or.tts ,,r. I Contact Juris.: ® Sec Page 2 for
24 -hour Inspection Request: 509 IN�D1 -' - Name/Method: - Supplemental Information.
,. ' • ' - '•TYPE.OF WORK ` • , • : .- ' •. FEE* SCHEDULE sp`ecial use checklist) • ,
New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition /alteration/replacement 0 O t h er: ...... •• New -1�•8&-2-fam ll „dweuidgs; ' - :;
••!A.• CATEGORY OY:,CONSTRUCTION,.. • = •'
: ' i u'tiliti'connection) • • :-
1 & 2- Family dwelling 0 Commercial/Industrial SFR (1) bath 249.20
ccessory Building Multi-Family S SFR FR (
g . '[] Multi -Famil (3) bath 399.00
❑ Master Builder • a Other: Each additional bath/kitchen 45.00
. .:JOB SITE INFORMATION and LOCATION ': " -- Fire sprinkler - sq. ft.: Page 2
Job site address: fQ Li ! S .S tv Lc. / n tG1/ t0.) t,/ - ": '•. :•' -.r:•;.,•'; :, Stto,.Utilities :• ;. : :; . ,. 1. , . •. • .
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: '% j��/jolteOci [OT [} Drywell/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
S.Lt,) 1 I H j R-0 Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 'Thal" 0 Ge oc'CZ I Lot #: G I Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: S S Q 4,-, Water service (no. linear It; Page 2
• • . . ';= , DESCRYPTION OF .. ` . : Absorption valve 16.60
Ln -1'16I S Cap 4- V CLCIC how azo [ C� Backflow preventer / Page 2 .'7- SS'
Backwater valve 16.60
Clothes washer 16.60 -
Dishwasher 16.60
-
Drinking fountain 16.60
;PROPERT.Y;OWNER ' I' 0- TENANT : - ._ Ejectors/sump 16.60
Name: Cdr m CSYtS.f3 e- 1-k -y,C-S Expansion tank 16.60
Address:} 230 ...c.. IA) &ct.L¢-w0 CI, Fixture/sewer cap 16.60
City /State/Zip: 1- 0-iZe. 04-w e.56 6 co 035 Floor drain/floor sinkAhub • 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
• IJAPPLI,CANT ' .. .. .I. '6LCONTACTTEESON :':,''" Ice maker 16.60
Name: F(1 aa) SPar-O Interceptor /grease trap 16.60
Address: / BO O Se- rniSIOYt.uu RD Medical gas - value: $ Page 2
✓ J Primer 16.60
City /State /Zp :"11Lt'�.ta1"1A- 0 Pt 970 (o a-- Roof drain (commercial) 16.60
PhoneS03 (o9a- - WI 451 Fax Soa bpi a- 076g Sink/basin/lavatory 16.60
E -mail: . Tub/shower /shower pan 16.60
::CONTRACTOR•' ... : ' . , , . , _ Urinal 16.60
te
Business Name: L i ..v' C 0 r j 16.60
C� oy (, _ Water closet
�J Water heater 16.60
Address: 1-D-0
.S.t -� rY1l aoTtj n. Other:
City /State/Zip: lt- to.ty. ± g_ tflO(o a - . Other.
PhoneS (tea- S4 jS Fax5)3 (4'94 - 07108 . - .. • ..--`' Pit;tubine,Periuit . ;'e:t• S
CCB Lic. #: 7er S
y Plumb. Lic. #: s7 $
Minimum Permit Fee 5722..50 50 $
Authorized Y 3Lo . s •
.2� 1 a. Date: / - (N 0 y i dential Backflow Minimum Fee Permit Fee
Si Plan Review (25% o Per mit Fee) $
Ell c r1 spar r e State Surcharge (8% of Permit Fee) $ ea? , 96
r (Please print name) . TOTAL PERMIT FEE $ .39, I 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 aRcr It has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i :lDsts\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 r ?i Date Requested 2 /. ( a/ Q 4 1 AM PM BUP
Location / 2- 4G � l / (L60 Suite L -7 1 MEC
Contact Person .0A. Ph ( ? 2 — E9 e/S j / 6
Contractor - vi..ce_Ae OR Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: /
Final r'
PASS PART FAIL /
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
O er Z jeuto
• PART FAIL
u - 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 , V I nspector .� Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL