Permit r
C ITY OF TIGARD PLUMBING PERMIT
I A` DEVELOPMENT SERVICES PERMIT #: PLM2003 -00517
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 13545 SW 122ND AVE PARCEL: 2S103CC -10500
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 052 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 for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES [PLUMB] Permit Fee 9/30/03 $36.25
4230 GALEWOOD STE #100
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 9/30/03 $2.90
Total $39.15
Phone : 503 387 - 3875
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 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
Issued B y: Permittee Signature: Wfd
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bu iness day
X' 25 03 02:29p clan edmonds 503 - 692 -0768 p.2
Plumbing Permi lication FOR OFFICE USE ONLY
EI t . Received G � � � Plumbing
V ED Date /Bv: / / .„,i Permit No.: e. , .4 r -695/
City tk Tigard Planning Approval Sewer
13125 SW Hall Blvd. SEP 2 03 Date/By: Permit No.:
9 20 Plan Review Other
Tigard, Oregon 97223 U Date/By:. Permit No.:
Phone: 03-639-4171 Fax: 5 0 Post- Review Land Use
19 4 e 'a'r t Date./By: Internet: www.ci.Eioard.or.us n C p � � � ir F � 1 GAR►_ ■ �� � �f�'� y: CaseNo.:
b39 =�I re , , C
24 -hour nspection Request: 50 V iS ^
r Contact
J ` See Page Z for
Name /Method: / I Supplemental Information.
TYPE OF WORK . 'FEE * SCHEDULE (for special information use checklist)
,New construction ❑ Demolition Description 1 Qty. I Fec(ca.) Total
❑ Addition/alteration/replacement , ❑ Other: New I, & 2- family dwellings I
CATEGORY OF CONSTRUCTION SFR (l) (includes 100 ft. for :each utility connection)
�I & - Farnily dwelling C] Commercial/Industrial bath 249.20
I�I so Building SFR (2) bath 350.00
Acc tY g ❑ Multi - Family SFR (3) bath 399.00
Mas er Builder ❑ Other: Each additional bath/kitchen 45.00
iJOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site t ddress: /3St!5 SU) /.)-�rt, A-tte- Site Utilities ' `
Suite #: i Bldg. /Apt. #: Catch basin/area drain 16.60
Project I ame:Cuku.sf/crs 1&)C' f lc S�J DrywelUleach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
5 � ) / .c7 r �
Manholes _ 16.60
Rain drain connector - 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivis on: Wit ,$ t t.rS C )Ja I Lot #:-S.2._., Storm sewer (no. linear ft.) Page 2
Tax map (parcel #: (p : (� Water service (no. linear ft) Page 2
I :, DESCRIPTION OF WORK Fi or Item
LGt a - i! ° �' ��G{ld� Absorption valve 16.60
f Backflow preventer / Page 2 ..7-7. 5S
Backwater valve 16.60
Clothes washer 16.60 _
I Dishwasher 16.60
;1'ROPEIRTY OWNER Drinking fountain 16.60
I ❑ TENANT
i Ejectors/sump 16.60
Name:D )1 t�h(O s
Yi ,,t/ : j (S Expansion tank 16.60
Address:iL --,3o .S o.
ctLu_ Fixture/sewer cap 16.60
City /S tatje /Zip:La. e �t � L .6 Ok rj"Jp3S Floor drain floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fy Hose bib 16.60 '
tELAPPLIdANT
_IS CONTACT :PERSON ::: Ice maker 16.60
Name: El len Cparrukki Interceptor /grease trap 16.60
Address: jip2.a43.0 S tf rn i.tc1Yly giD Medical gas - value: $ Page 2
City /Stat& /Zip: TIA_ L .cLt lyk, Q iC- C/'/() dL Pourer 16.60
Roof drain (commercial) 16.60
Phone:Sca3 to q a - s'i -1 Fax: So3 loq* - Q'I(oE- Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR. Urinal
16.60
Business N ame: Licna.t cc- - Ori:c�cm Z-.,� Water closet 16.60
Address: j {jp ' tO 019g/431'1g Water heater 16.60
co • Other:
City /Stat /Zip: - rub �, Q 9706 Other:
Phone :5 a .1 -3 6 9 -5 L/S Fa x :SO3 6 x'02 -07e P Plumbing Permit .17, sis-
CCB Lic.l #: - 7 ecw Plumb. Lic. #: Subtotal $
Authorized l Minimum Permit Fee S72.50 S
Signature: Residential Backflow Minimum Fe 3E f 5 , '3 - arS
��fJ h 1 Dat e: Plan Review (25% of Permit Fee) $
-61. State Surcharge (8% of Permit Fee) S • 96
(Please print name) TOTAL PERMIT FEE S .31 . ( S -
Notice: This (f 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
.1 ..
orms\PlmPermitApp.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 I o - �` AM PM BUP
Location l3S /2Z. A-v2• Suite MEC
Contact Person 11 - e.t e x Ph ( ) 0092 - 59 3 - 0 D S/ 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear 6 - C/ ^, - L
J GJ ' T S�
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
RT FAIL
• F. • - am
tinder lab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P
Other: Pia).
F'•
r9SEIP PART FAIL
MECHANICAL
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 /o /� /
Approach/Sidewalk Date �` Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL