Permit P
C ITY OF TIGARD PLUMBING PERMIT
A l A DEVELOPMENT SERVICES PERMIT #: PLM2003 -00519
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 13745 SW 124TH AVE PARCEL: 2S103CC -06200
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 009 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
4230 GALEWOOD ST [PLUMB] Permit Fee 9/30/03 $36.25
STE 100 [TAX] 8% State Tax 9/30/03 $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 : 503 692 - 5945 RP /Backflow Preventer
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
S
7
Issue y I �,( _/ Permittee Signature: ` 4 �/ e , ' e.
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Sep 29 03 02:41p dan edmonds 503 - 892 -0768 p.
{ FOR OFFICE USE ONLY
Pluming Permit Application pl ca eiO Received ,..., , / , Plumbing / � / �
DateB / : 4 43 1/!/ Permit No.: ��
/`III Planning Approval Sewer
City of Tigard - 0 I 4 y `VUj Date/13 : Plan Review Permit No.:
Ocher
13125 SW Hall Blvd. Other Na:
Tigard, Or gon 97223 CITY OFT!; gD DateB ' Land use
O � Post - Review
Phone: 503- 639 -4171 F� &x'19601 ;. j t Da
Post-Review
: Case Ho.:
�! t w (( Jwi : +7. See Page 2 for
Internet: www.ci.tigard.or.tis A, e•1 f Contact r ., Su , lementai Information. Inspection Request: 503- 639 - 4175 Name/Method:
TYPE. OF WORK ;, • ..:`' FEE* SCHEDULE (for special information use checklist)
[ � Demolition Description Qty. Fee(ea) Total
_ New construction ::-
, l
New - & 2- family. dwellings
' Additkon/alteration/replacement ❑ Other: rapt ,yes 1p0' for f each 2-family
utility coaaecf on)
} i` CATEGORY OF CONSTRUCTION `, SFR(1)bath 249.20
�i & Family dwelling n Commercial/Industrial SFR (2) bath 350.00
Accessory Building ❑ Multi- Family _ SFR (3) bath 399.00
Q Mastr Builder , ❑ Other: Each additional bath/kitchen 45.00
` 1OB SI TE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
9 nA' . .. -.- ,':2::.::"....' Site :Utili6es: : s`i' ,
Job site i ddress: /3'2 q S �� �` / L f y7� t%� Catch b n . la r ea d r;. ain 16.60
Suite #: I Bldg. /Apt. #: Drywell/leach line/trench drain 16.60
Project STame: (.t-h -tS f t S L L)CLLIC (0 T 5 Footing drain (no. linear ft.) Page 2
Cross s l eet/Directions to job site: Manufactured home utilities 110.00
CC�,, �}-,..}-e__:
Manholes 16.60
cl�`' �� S YT Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Storm sewer (no. linear ft.) Page 2
Subdivi :i..01.4 �fitr W k � Lot #: a 5 water service (no. linear .) Page 2
Tax ma /parcel #: 60 CS �� _ : ... :,..' Futture or Item
_ .':DESCRIPTION OF WORK va ?;::.:
Absorption valve 16.60
Land5 Capz C,GIChOtlJ dO Backflowpreventer I Page 2 ,,./r2... s5
1 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
' PROPERT OWNER - I 0 TENANT °-•`.''' :::.. Ejectors/sump 16.60
Name: Dtwl PY) (iii e- / c'S Expansion tank _ 16.60
Address : 30 S.ti GLLQWOO f Fixture/sewer cap _ 16.60
� /seww r c sink/hub 16.60
a
City/Sate/Zip: L13�I�f- 6 �li Floor /se Garbage disposal _ 16.60
Phone: Fax Hose bib 16.60
"•jaAPPL� 1CANT'' '. . �`:..�:- ' .. ` . ` ';,LCONTACL PERSON :. Ice maker 16.60
Name: el 1 cry Spa -rre & Interceptor /grease trap 16.60
Addles: ! D.....-0 6 C to rn t( .. 9 (D Medical gas - value: S Page 2
Primer 16.60
City /State /Zip: - 1 - 1,4_0-k0-1 - 1N..- 0 le- 970 6 -' Roof drain (commercial) 16.60
Phone 3 Co Rs. - Si 45 1 Fax:563 tog .3.- 07b g Sink/basin/lavatory 16.60
Tub shower /shower pan 16.60
E -mai � Urinal - 16.60
G -':: : ' ::CONTRACTOR Water closet 16.60
Businss Name: Lo ;odSCc t . 0 t��tdln C> Water heater - 16.60
Addres: ID-DD -00 Sy-) �'l) t .ci \ P-D r
. _ Other:
City /Sbtate/Zp: TVLO to .t r,_ ± #L -- co 6C0 D- Other Plumbing Per Fees ?ASS
PhoneSh (� - SR `� S' Fax�3 (.0901 - ?1a Subtotal S
CCB Lie. #: `7kt)r ! Plumb_ LIC.#: Minimum Permit Fee 572.50 S 36, S
Authori V D _ Residential Backflow Minimum Fee 5536.25
Signatu ��v DatellJ /' � � Plan Review (25% of Permit Fee) S
El/ 4 ( r [/ t ! � a_r rota State Surcharge (8% of Permit Fee) $ e2 , /b
C' (Please print name) TOTAL PERMIT FEE 5 3% / '
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 dar after it bas been accepted as complete. riser diagram for plan review.
'Fee methodology set by Tri- County Building Industry Service Beard.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
2,� BUP
Received Date Requested /6 -�7 A ` . ' AM PM BUP
Location � 3 7 I s �< t Suite MEC
Contact Person Ph ( ) PLM 3 -00-57 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
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: U
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
: r .
AS PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final LI Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date V906/6s Inspector _ j Y 7 74, Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL