Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: P /13/03 00538
_.f �l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/13/03
SITE ADDRESS: 13715 SW 124TH AVE PARCEL: 2S103CC -06100
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 008 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
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 10/13/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 10/13/03 $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: Permittee Signature: Am
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
0 03 02:55p clan edmonds (e 503- 692 -0768 p.2
. • FOR OFFICE USE ONLY
Plumbing Permit Application Received9 Plumbing , oDS
Datr/By: 7' Jj�• Permit NgCe0a00.3 '
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
Other
13125 SW Hall Blvd. DatdBy: • Permit No.:
Tigard, Oregon 97223 p�t_R [and use
Phone: 503- 639 -4171 Fax: 503 -598 -1964 ,,.,,; ; ,. ii,
Plan Review
Date/By: Case No:
Internet: www.ci.tigard.or.us X 14. PI J Contact 3uris.: I ® See Page 2 for
24 -hour Inspection Request: 503 -639-4175 " �" Name/Method: Supplemental Information.
FEE* SCHEDULE (for special inforination:use checklist)
TYPE OF WORK HEDIJI.E o
• (fo
. , . ' , , l Qty.. L Fee(ea.) Total
tSt New onstruetion ❑ Demolition Description Q y
New 1- & 2-family dwellings !.
El Addi - on/alteration/replacement Other 0 r (inclu ft. for eseh utility connection)
CATEGORY OF.CONSfRUCTIQN SFR (1) bath 249.20
I & - Family dwelling ❑ Commercial/Industrlal SFR (2) bath 350.00
O cce-sory Building . 0 Multi - Family SFR (3) bath 399.00
❑Mast - r Builder
Q Other: Each additional bath/kitchen 45.00
OB SITE INFORMATION and LOCATION Fire sprinkler sq. ft Page 2 _
. , °. ; Site Utilities site : ddress: l Ss o � 3 St. i ( - 1 Li tri 7 c.i C . - Catch basin/area drain 16.60
Suite #: ]Bldg. /Apt. #: DrywelVleach line/trench drain 16.60
Project ame: EIM f 1 es V.' ) /o v Footing drain (no. linear ft.) , Page 2
Cross s' eet/Directions to job site: Manufactured home utilities 110.00
Lot ti ,e,r W Ct_t Manholes 16.60
I` Rain drain connector 16.60
Sanitary sewer (no. linear ft.) _ Page 2
Storm sewer (no linear ft.) Page 2
Subdivi ion: U Page 2
��-�' / � <� V/ �'O I Lot #: � Water service (no linear f1�
Tax ma o /parcel #: je.Sii 7 Fixture oriteni
DESCRIPTION OF WORK . '..- Absorption valve 16.60
LZnj 4 C p1 - C-1ChOU) clef) ice) • Backflow preventer i _ Page 2 .. j_ SS
Backwater valve 16.60
Clothes washer . 16.60
Dishwasher 16.60
Drinking fountain 16.60
' S,PRO " ERTY OWNER - ` .1 0 TENANT - Ejectors/sump 16.60
Name: Dar !Y) (SY'rs. 1 --lery S Expansion tank 16.60
Fixture/sewer cap 16.60
Addre - s:4 BO emu) C�a Lit CL, Fioordrain / floor sink/hub . 16.60
City /S • to /Zip: 1.A.5-1 'C C) 470 Garbage disposal . 16.60
Phone: Fax: Hose bib 16.60
APP 1 ICANT . 'Si CONTACT PERSON . Ice maker 16.60
Name: 01,1cri C „ -0 Interceptor /grease trap 16.60
d CIA YY 1 U l�d9 2Y} Medical gas - value: $ _ Page 2
Addr s: l� 16.60
City /S . to /Zip: 71,�CiL 1 t\. 0 1 2 9 to a--. Ro stain (cotnanercial) - 16.60
Phone - ►3 (off.. - S i 51 Fax:563 (o9 a,- o7 1a 2 _ Sinlc/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E :
Urinal 16.60
CONTRACTOR . _
Water closet 16.60
Busin • ss Name: L0.-n .-.Ca pt.. a (�3QY1 Th C, Water heater 16.60
Addre . s: l?-D-0 5 RA. rywi.givnj AID. other:
City /S ate/Zip: R..o-t R., t rloc° D - Other.
�; Plumbing Permit Fees* x '7: 55
Phone 03 lr�la - 5 S Fax�3J3 (DCId - X710 Subtotal _S
CCB I ic. #: "7)'-f Plumb. Licit: Minimum Permit Fee 572.50 $ 3 jo � -
Autho ' ed ,, Residential Backflow Minimum Fee $36.25
Signs ,e - 42-4.-A-1-7-0 Date:• a j 1 Plan Review (25% of Permit Fee) $
G7 ` 4 \ ar O � State Surcharge (8% of Permit Fee) $ . 9 6
C r (Please print name) TOTAL PERMIT FEE S 37. / S
Notice: his permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with Isometrit or
180 day - after it has been accepted as complete. riser diagram for plat review.
*Fee methodology set by Tri- County Building Industry Service Board.
CITY OF TIGARD 24 -Hour -�
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/2:3q BUP
Received /2 Date Requested 12 - / 13/0 3 AM PM BUP
Location / ,3 7 / 5 / 2- q Suite MEC
Contact Person �lQ.� � Ph ( 5i'2 2)) - $ , A 3 - 0 053?
Contractor Ge 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
457P-1' / ';
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower • an ,
O =r•
1
' PART FAIL
" CHANICAL
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: Unable to inspect – no access
Fire Supply Line � � v �
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL