Permit CITY OF T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00354
..� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/18/03
SITE ADDRESS: - _ . • - • I I • - PARCEL: 2S103CC -07400
SUBDIVISION: WHISTLER'S WALK 3580 I2 ZONING: R -4.5
BLOCK: LOT: 021 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 INC
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 7/18/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 7/18/03 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062
REQUIRED INSPECTIONS
Phone : 503 RP /Backflow Preventer
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 By: r Permittee Signature: Ai / e _ �d
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the next • u ness day
Jul 17 03 04: 12p dan edmonds 503 - 692 -0768 p.1
. FOR OFFICE USE ONLY
Plumbing PeAi tti ti1On Received (�,,y� -�/� Plumbing dy
I t Date/By: Q t ' Permit No.rgn ae1 -05 35 Li
Planning Approval Sewer
City of Tigard Date /By: Permit No.:
J UL 1 Plan Review Other
13125 SW Hall Blvd. Date/By: Permit No.:
Tigard, Oregon 97223 Date /By: Land Use
II>$3GA81K RD Land Us
Phone: 503 - 639 4171 Fa i ` 't c Contact Case : El See Page 2 for
Internet: www.ci.tigard.o ttiiL DIVISIO e'l e i Contact
24 -hour Inspection Request: 503- 639 -4175 Supplemental pp lemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
`- ❑Demolition Description Qty. Fee(ca.) Total
New construction New 1- & Z= ialnily dwellings
[11 Additionlalteration/replacement ❑Other: (incindes loll ft. for each utility connection)
CATEGORY OF CONSTRUCTION. SFR (1) bath 249:20
' 1S1,1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00
❑Accessory Building ❑ Multi - Family SFR (3) bath , 399.00
El Builder
❑ Oth er: Each additional bath /kitchen 45.00
Page 2
JOB SITE FORMATI • .. and L! CAT • N Fire sprinkler - sq. ft.: Pa
��� !� , Site Utilities
Job site address: , j ! ' , C,� Catch basin/area drain 16.60
Suite #: Bldg. Apt. #: 16.60
_ Drywell /leach line /trench drain
_ Project Name: Will's-4- s Lk' %at is t' .a Footing drain (no. linear R.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
1--1 7 .S, Manholes 16.60
�'� Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2 _
Storm sewer (no. linear ft.) Page 2
Subdivision:lt;il Sf'ly' U=�� I Lot #: P.-/ Water service (no. linear ft..) Page 2
Tax map /parcel #: 6 5 a 5 Fixture or Item _
DESCRIPTION OF WORK Absorption valve 16.60
` t- e-k•FIC'Z Backflow preventer / Page 2 .2.7 -
� '�`��� �� I j/ �`` C C31�1 Backwater alve 16.60
Clothes washer 16.60
_ Dishwasher 16.60
Drinking fountain 16.60
`1.kROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
S E tank 16.60
Name: jD-CVI j') ell s - -- 'yYk- 16.60
Fixture/sewer cap
Address: 1-e" 3L V Cu C�c r� Ccc.L - Floor drain /floor sink/hub 16.60
City /State /Zip: Lake i�Si ie / ff. C O 9 7 y Garbage disposal 16.60
Phone: S [04 - S9YS Fax -.3 (agA - 67402 Hose bib 16.60
I ,ZPPLICANT • .� 1:CONTACT PERSON Ice maker _ 16.60
Name: rf / E.7
` f ,�) Interceptor/grease trap _ 16.60
- Page 2
Address: /a)-00 gal t,�/�� �/ Primer Medical gas value: $ 16.60
City/State /Zip:?LLL -4'Yl- 0,Q, q 7v to �- Roof drain (commercial) 16.60
Phone..5D3 oga sept s f Fa iD3 ti 9,;.? -O'768 Sink/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business Name: L ' '- a 7 . cY i ›� - Water heater 16.60
Address: % .P',,)-C.)(..) S ! SIC f Other: -
City /State /Zip:7 Li.LL- eA -1)(.) Cie.., 9 7d Oct a. . Other:
Fax: (a9 - Plumbing Permit Fees*
Phone: 6/Q,..) 59 J S I 076 Plumb. Lic. #: Subtotal $
CCB Lic. #: °��- V Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25 &
= - c
Signature: GUL t.. LL �/ te: / " / 7 -6.9 Plan Review (25% of Permit Fee) $
% ell \ S pa-rral-, -3 State Surcharge (8% of Permit Fee) _ $ . 9 •
(Please print name) TOTAL PERMIT FEE $ 39 • /S
Notice: This permit application expires if a permit is not obtained within All n new diagram commercial buildings r 2 sets of plans with isometric or
180 days after it has been accepted as complete.
*Fee dia ogy set by viei- County Building industry Service Board.
- is \Dsts\Permit Forms \P1mPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILD►»li ' Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
t huP
Received Date Requested - 7 - a AM PM BUP
Location Suite �G J MEC
Contact Person / 33 /2 q Ph ( ) PLM 3-66 354.{
Contractor 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 1
Susp'd Ceiling
Roof
Other:
Final \ 1 /
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: Qy '
PART FAIL
ICAL
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: 0 Unable to inspect — no access
Fire Supply Line '7
ADA Date 7/.? !k /O3 I ector / Ext
P
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL