Permit C ITY OF TIGA • PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00214
DATE ISSUED: 5/22/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13685 SW 124TH AVE PARCEL: 2S103CC -06000
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 007 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: Install irrigation backflow preventer.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES INC
4230 GALEWOOD ST #100 [PLUMB] Permit Fee 5/22/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 5/22/03 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062
REQUIRED INSPECTIONS
Phone : 503 692 - 5945 Sprinkler Final
Reg #: PLM 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: `/ � �,� � L /' Permittee Signature: pf _j j a I
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
May 21 03 G5:05p dan edmonds 503 - 692 -0768 p.2
Pl-u wing Permit A licatioII FOR OFFICE USE ONLY
- Date/By: _ ,. e.
Plumbing ,-
1 RECEIVED Date /By: r J 'c�a 0� �[}t� Permit No. ) - �d��� ---04X City of Tigard Planning Approval Sewer
Date /BV: Permit No.:
13125 SW Hall Blvd. y 2 c 2003 Plan Review Other
Tigard, Oregon 97223 MA Datemy:. Permit No.:
• Phone: 503- 639 -4171 Fax ' , , Post- Review Land Use
� ( t� Contact Case No.:
Internet: www.ci.tigard.or.0 n1r n' �/�S� , R"° e` I , �, j, I� + Contact Juris.: ® See Page 2 for
24 -hour Inspection Reques : �d3�. -'4115 Name /Method: Supplemental Information.
TYPE OF WQRK . FEE". SCHEDULE (for i on nse: checklist):'
FIED nformati
New construction ❑Demolition
Addition/alteration/replacement �❑ Description Qty. Fec(ca.) 1 Total
• Other: ..:. New 1- & • 2- family dwellings
• (includes 100 ft for each utility connection)
CATEGORY OF. CONSTRUCTION SFR (1) bath 249.20
M 1 & 2-Family dwelling El Commercial/Industrial SFR (2) bath 350.00
Accesso Buildin; Multi-Famil 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: /36 Q"5 ..u: 4. 117 #410. Site Utilities .
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell/leach line /trench drain 16 -60
Project Name: W JLr S *i i LV CLU-lG U::% O'7 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities (10.00
Li..V /‘)/ £- fri-_ Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: U%i1 i it P /,li aL.k 1 Lot #: 0 P7 Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2 _
Tax map/parcel #: . 8 S . ; , :..; Fixture or Item .
DESCRIPTION OF WORK Absorption valve 16.60
(. a_ (Fe �s. k :c.- y-C- C- ,i,,Ivi G' -U LC_.&) - Backflow preventer / Page 2 .'7.
f " Backwater valve 16.60
• Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER 1 0 TENANT Ejectors/sump 16.60 1
Name: Dm h'1 L)h '1e t-i-cyyy6S Expansion tank 16.60
e i etto W cOc{ � _ Fixture/sewer cap 16.60
Address: Z3 �. t Floor drain /floor sink/hub 16.60
City /State /Zip: iCt ��. (ttY ��c> C3 Q �!`7� 3 Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
'SqAPPLICANT ... C] CONTACT PERSON • : Ice maker 16.60
Name: C1! to S.n fl' - tv Interceptor /grease trap 16.60
Address: /3? G c4- ITN- LiSicr .O Medical gas - value: S Page 2
`� �c
Primer 16.60
City /State /Zip:�d.t(Xt ^�)L �/ ^ C/ - Roof drain (commercial) 16.60
Phone:SI (0qa -.S' '- /�1Fax:Via - Sink/basin /lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR .
:: Urinal 16.60
Water closet 16.60
Business Name: 1 A_Act'cc or-r-ccie _
Water heater 16.60
Address: ' Y 1)-G O t -i' t) . y C'k y PO Other:
City /State /Zip: 2 -Lf -f0 t,t O /2: 91 Other:
■
Phone: Fax: - Plumbing Permit Fees*
Subtotal $
CCB Lie. #: Plumb. Lic. #: Minimum Permit Fcc S72.50 $ // �S
Authorized Residential Backflow Minimum Fet; 836 S
Signature: Date: Plan Review (25% of Permit Fee) $ _
State Surcharge (8% of Permit Fee) S . % e)
(Please print name) TOTAL PERMIT FEE S .3 9; f J
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 as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
is \Dsts \Permit Forms\PlmPerrnitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received Date Requested C� �° AM PM BUP
Location /.3 85 /o?' VP ' / O ,, -- Suite MEC
Contact Person Ph ( ) PLM 3-00/
7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access
Ftg Drain / ELR
Crawl Drain /`' / SIT
Slab Inspection Notes:
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof w ��
Other:
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan ,
Ot - • ' —
4114
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 ❑ Please call for reinspection RE: Unable to inspect – no access
Fire Supply Line
ADA Date ., / Inspector v ' ✓
A Ex{
PP
Other:
Final DO OT REMOVE this inspection record from the Job site.
PASS PART FAIL