Permit •
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00122
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/3/03
SITE ADDRESS: 13775 SW 124TH AVE PARCEL: 2S103CC -06300
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 010 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 residential backflow preventer.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 4/3/03 $36.25
STE 100 [TAX] 8% State Tax 4/3/03 $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 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 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: &// 4/,, 41:1(}L. Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Apr 01 03 09:56a clan edmonds
-► 503 - 692 -0768 p.
• FOR OFFICE USE ONLY
• Plumbing J w � a �
1011 Received Permit No: l� ) ;" - "
P1umlbiL Pe Date/B : - �
Planning Approval
Permit Ho.:
Date/B : Other
of Tigard AP 0 1 20 03 Plan Review Permit No.:
13125 , Oregon Hall Blvd. Date/B :. Land Use
Case NO.:
Tigard, Oregon 97223 CI See Page 2 for
i' �d5di9D �.?:�I�;i�, v ac
Phone: 503-639-4171 Fed: ® Su lemcntal Information.
Internet: www R eque J t: Name/Method: DING DIVISION 1�.
24 -hour Inspection Request: 503 -639 -4 `
. FEE* SCHEDULE (for special'' information use checklist)
• TYPE:OF -WORK , : Descri . tion �
/I Demolition New 1- & 2 fam►ly dwellings Taal
�! New construction ether:
L New
100 ft 2- 2-family utifi connection
CATEGORY' OF CONSTRUCTION
■ Addition/alteration/r slacement 249.20 -
SFR I bath 350.00 -
[ ] Commercial/Industrial SFR 2 bath 111111 39 -
V, 1 c 2 B dwellin: SFR 3 bath 45.00
INFORMATION
DI Masteo Buildin: / Multi -Famil
Each add itional bat kitchen
■Master Builder MI
■ Other:
JOB SITE . and LOCATION . 16.60
Job site address: / 3-7 •7 S S Ic � Catch basin area d 16.60 - MOM
Bld f ./A • t. #: Catch
ell/leach roach line/trench drain drain P 2 -
LoT I0 Footin: drain no. linear 8. ► age2 -
Pro Cross Name: e i r S " f' job ii i Manufactured home utilities 16.60 111111111111 Cross street/Directions to job site, Manholes 16.60 - 1111111 p FF- (a / r Rain drain connector
Sanita sewer no. linear ft. 111111 Pale 2
Storm sewer no. linear ft. P� -
�e%cc�' -,c- Lot #: !U Water se rvice no. linear ft. NMI . :
Subdivision: c. ill S Fixture or 1ten • ' 16.60
- DESCRIPTION OF WORK A • lion valve �'�!�
KT 't.."_.. Backflow •reve i 16.60 r MOM
g Q- C IC elf G`� 16.60 MIMI
Clothes washer 16.60
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Dishwasher 16.60 -
Driinkin: fountain 16.60 -
E'ectors/sum• 16.60
�(s! 1QIROPER''OWNE `' (� Ex•ansiontank Interce tra• 16.60 . 111111111 MMONNINIM
r7 t 16.60 - Milili
3 p �� e et . Cs' Floor drain/floor s i n k/hub r 16. 0 -
Address: CC) 0/2_ 7c 3S Garba_edi .oral
Ci /State /Zi � : -1,..„ - � •� t'� 16.60 r
Hose bib 111.11 16.60
Phone: rz , ON TACT PERSON MI 16.60
� ' _ MON
4. Pae 2 W Ad ��/ C . Medical : as - value: 5 16.60
Addr 16.60 IMMO
Roo drain commercial 16.60 -
�� • teC - 074/ . Sink/basin/lavato 16.60
Phone Tub /shower /shower .an 1111111 16.60
16.60
CONTRACTOR Wate closet 1b.60
Business Name: eISC - • D C. n A ether:
(2- ►
Address: ECG ` ' L S ate. Other: --
Subtotal $
L/� - -7L & 0 --- , P.ltiiubin _ .Permit Fees*
Ci /State /zi • : -- L C�-� / , eta _ G .� �.�
Phone: l'cy� - 55 Fax
of Permit Fee $ S
CCB Lic. #: 7 FO Plumb. Lic. #: Minimum Permit Fee $72.50 $
Residential Backflow Minimum Fee $36.25
Authorized � ! � ���u.•L(� D ate:? l �` Plan Review 25% of Permit Fee $ ��
dot Signatury' State Surchar:e 8% 2 /s--- ' 1 CGY i TOTAL PERMIT FEE $
(Please print name) AU new commercial b t gsrequire 2 sets of plans with isometric or
Notice: This permit application expires if a permit is not obtained within riser diagram for p
180 days after it has been accepted as complete. ■ s e r diagr for set review. ei -County Building Industry Service Board.
i :\Dsts\Permit Fonns \P1mPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
L,� BUP
`
Received Date Requested — ift AM PM BUP
Location ) � � 7 73 /4q " '4(/` - Suite MEC
Contact Person Ph ( ) to ?. S 'S PLM 5-00/-2
Contractor Ph ( ) X SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ACC @S ELC
tri Ftg Drain A I$ r G `„ c ELR
Crawl 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 60,--i / Susp'd Ceiling -
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan 6, r
Other:
itia
S 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 111 Please - I for reinspection RE: In Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date Id 6 Inspector /7 `/ �j Ext
Other:
�f/
Oth J"
Final DO N • T REMOVE this inspection record from the Job site.
PASS PART FAIL