Permit s �
C ITY OF TIGARD PLUMBING PERMIT
L�* ek DEVELOPMENT SERVICES PERMIT #: PLM2003 -00238
s ;:
DATE ISSUED: 6/3/03
� ._:. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12485 SW ASPEN RIDGE DR PARCEL: 2S1106C TS003
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 003 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 INC
4230 GALEWOOD ST #100 [PLUMB] Permit Fee 6/3/03 $36.25
LAKE OSWEGO, OR 97034 [TAX] 8% State Tax 6/3/03 $2.90
Total $39.15
Phone :
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 692 - 5945
Final Inspection
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
Issu • d By: , % %/ ; am.
/�%/' Permittee Signature: / fA7I /
Call (503 ;39-4175 by 7:00 P.M. for an inspection needed the next bu i ess day
lit 03 02 :27p dan edmonds 503 - 692 -0768 p.4
turibing Permit Application TOR OFFICE USE ONLY
Received Plumbing )
�i+ -' �� Date/By: Permit No.: zw,Po/D '. o /,�, 5 q
City of
1 igard i Planning Approval Sewer
13125 SW Hall Blvd. Date/By: Permit No.:
Plan Review Other
Tigard, Oregon 97223 • G 2 Date/By: y Permit No.:
Phone: 503- 639 -4171 Fax: 503- 598 -1960 Post Review Land Use
Internet: www.ci.tigard.or.us v ' r71.re'ill'a' Date./ Contact No.:
24 -hour Inspection Request: 503 - 639- 417S,y,r_., _AL. e "" Contact � J_�uur� .' � ( ® See Page 2 for
t.at. .� Name/Method: 00 , I Supplemental information.
TYPE OF WORK ,': F E E * ..
SCHEDULE (for speciaC information use checklist)
N. New construction ❑ Demolition Description 1 Qty. J Fee(ea.)J Total
❑ Addition /alteration/replacement ❑ Other: New 1- & 2- family: dwellings
•
CATEGORY'OF.CONSTRUCTION (includes 100 ft. for each utility connection)
rN & 2- Family dwelling ' ❑ Commercial/Industrial SFR (1) b 249.20
Accessory Building E] Multi - Family SFR (2) bath 399.00
(
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: /.) .f - S - S - c - u . �. r a
� / � 1'. // . : '` : - Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: '7 a*Yr) w o ( /-- Drywell/leach line/trench drain 16.60
Cross street/Directions to job site: Footing drain (no. linear ft.) Page 2
Manufactured home utilities 110.00
Manholes 16.60
•
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 7 ho r i -c cott, (07 g Lot #: o Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK
Fixture or Item
(eel is Cap_...; //7 /4?" /1�7'DYl t I Cr p Absorpt valve __ age 2
/ ctcac-- Backflow preventer / Page 2 ..,1'7,SS"
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER Drinking fountain 16.60
TE
Ejectors /sump 16.60 1
Name: boy, in OYIS Sre../1-K. Lic rr'tc'S Expansion tank 16.60
Address: y -�:,,p S_F,O cj^A.1.0AxaocL Fixture/sewer cap 16.60
City /State /Zip: Laz e 0 , + C 976:3c1 Floor drain /floor sink/hub 16.60
Phone: Garbage disposal 16.60
Fax:
[] APPLICANT Hose bib 16.60
0 CONTACT PERSON I maker
Name: 0 Mil i� 16.60
In / grease trap 16.60
Address:/,?-300 S11) m 00m4 12-0 Medical gas - value: $ Page 2
City /State /Ziri:TU 7 L- 6 k--,( 970 Primer 16.60
Roof drain (commercial) 16.60
Phone:503 (094-S9 £1S 1 Fax:503 icW-- O'7? Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
.• CONTRACTOR:. Urinal .:.:. rna 16.60
Business Name:Lfl4(S«.Lp Cr e �� Water closet 16.60
Address :/,,.--)-0C..) t.LU j'� Livery' L R,) Water heater 16.60
City/State/Zip: 73e1 � & CR - "e 7 0 Co --- Other:
Other:
Phone: Fax: Plumbing Permit Fees* ' '.9 SS'
CCB Lic. #: 76 -o t -% Plumb. Lic. #: Subtotal $ .
Authorized t ( �, Minimum Permit Fee $72.50 $
Signature: S 04 � /)f
Plan Review (25% of Permit Backflow Minimum Fee $36.25 (.3.:,
7 / Fee) $
L l /&i 'S/2 y rzyuL) State Surcharge (£4%ofPermit Fee) $ a, ,b
(Please print name) TOTAL PERMIT FEE 5 3 /.5
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.
i :113s ts \Permit Forms\PlmPermitApp.doc 01/03