Permit CITY OF TIGARD
PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2003-00561
"' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/28/03
SITE ADDRESS: 12170 SW KELLY LN PARCEL: 2S103CC -08700
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 034 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 backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES INC
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 10/28/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchan 10/28/03 $2.90
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 #: LIC LCB: 7804
PLM ALL PHASES - PLC
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
A ir
I. sued By: k • .9
�:� / . , ► / ✓, Permittee Signature: ;� . !�n�
Call ( I - .39 -4175 by 7:00 P.M. for an inspection needed the next business day
x 3 01:37p dan edmonds 503 - 692 -0768 p.2
•
•
ro bing Permit Application FOR OFFICE USE ONLY
Received 41.5 Plumbing 1
Date/By: /e /a� Permit No_: ageas"Doro
Ci �, of Tigard Planning Approval , Sewer
`.1 g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Revie Other
• Tigard, Oregon 97223 • Date/By: Permit No_:
Phone: 503- 639 -4171 •Fax: 503-598-1960 • Post Review Land Use
/ 3 r�, t?\
Date/Ely: Case NO.:
Internet: www.ci_tigard.or.us . i b Cq li I
Inspection Request: 503 - 639 -4175 J e " Contact z Su See page l for
24 -hour I
�P 4 Name/Method: �, SupplementaInformation. ,
•
TYPE :OF WORK FEE *:SCHEDULE (forspecial mforniabon use checklist),:
❑ New construction ❑ Demolition Description 1 Qty. I Fee(ea.) ) Total
... • • Addition/alteration /replacement ❑ Other: New;1 - 8c 2- family dv eUings
r ! ld
incuesi100,ft •fo' each u "tilt comimieetion
;.:; ,.. CATEGORY .,OF. CONSTRUCTION.;.:;;::,.:-.:,:!;:•,..:','. : -, - �, - .. Z _. i ,:.....
SFR (1) bath r 249.20
.1 & 2- Family dwelling (❑ Commercial/Industrial _ SFR (2) bath 350.00
QAccessory Building , ❑ . Multi - Family SFR (3) bath 399.00
❑ Master Builder • ❑ Other: Each additional bath/kitchen 45.00
.. . JOB SITE' INFORMATIONand LOCATION-' : ... Fire sprinkler - sq_ ft.: Page _2
Job site address: /.....i/ S i ✓ ice(' (j Cie.rl&i .: - -. - ::' `> :$ite - itiliiies : _ :`
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60 .
Project Name: WhiSf' /2,5 WC1./G. LeT , DrywetUleach line/trench drain 16.60
Footing drain (no. linear ft_) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00 .
s lu • /D--/ T ,4 Manholes 16.60 •
Rain drain connector 16.60
. Sanitary sewer (no. linear ft.) Page 2
SubdivisiorW11 i.S:fie - J watt_ I Lot #: `t' . Storm sewer (no. linear ft.) Page 2 •
n
Water service o. linear ft_ Page . 2
Tax map /parcel #: (m SS A.S :.. .
..:'Fixture:or- Item' .. ' .
. ?=DESCRIPTION' OF WORK : • .- :•:; Absorption valve 16.60
Lai td cap C GIC{1eui CL( ic•.A) Backflow preventer i Page 2 , '7_. S5'
Backwater valve 16.60 •
Clothes washer 16.60
• ' Dishwasher 16.60
Drinking fountain 16.60
. : P ROPERTY.:OWNER'.'.: :_L. TENANT -`'`?."::.::.':'.". ':.: :;. Ejectors/sump 16.60
Name: Day, ry) (y S� r)-ri tS Expansion tank 16.60
Address:} A 30 S.tu.) &eLLLU. 00 Fixture/sewer cap 16.60
City /State /Zip:1-1s - -- 0S-L ,e'515 gib Floor drain/floor sink/hub . 16.60
_ Garbage disposal _ 16.60
Phone: Fax: Hose bib • 16.60
" • - .:.:'_, :.:: - °Q.CONTACT:PERSON ";'.' • • Ice maker
16.60
Name: E icy Spei rYlf"L&) Interceptor /grease trap 16.60
. Address: / D-.)-o O 0.0 Y11 (}Y1U kip Medical gas - value: $ Page 2
City /State/Zip: 7t,l/kl A__. 0 te_ 9 to D-; P 16.60
Roofdr'ain (commercial) 16.60
PhoneS03 (n 9L - -S i 4S 1 FaxSIN3 (aq a- O7/a Si Sinlc/basin/tavatory 16.60
E -mail: . Tub/shower /shower pan 16.60
r ; CONTRACTOR ;: Urinal 16.60
Business Name: L A��dSC O rtyy .rt (� Water closet 16.60
Address: 1."D J Water heater 16.60 .
S rYl1 �tom- . Other.
City/State/Zip:. R. c 7o(o - Ot
PhoneS113 (dj - St2 Li S" FaxSD3 (it'd - ) 4 / Pluiribiug PerinitTees* ' '..` - :. '11'7 SS
CCB Lie. #: "7 ffbq Plumb. Lic. #: Subtotal $ .
Minimum Permit Fee $72.50 $ 3S.
Authorized
Plan Review (25% of Permit Fee) $ `, ,� Residential Backflow Minimum Fee $36.25
Si � 1 GL�1�1 -LLrL� Date:�v f c 1 '(O •
E j I Cri q - rzrta • State Surcharge (8% of Permit Fee) $ ,7 ,
(Please print name) . .. TOTAL PERMIT FEE $ 39. 1
Notice: This permit application expires if a permit is o FINCEIVEn An new commercial buildings require 2 sets of plans with isometric or
/8o days afcr it_ bas- been_accepted-as.comptete_ -C la riser diagram for plan - review. - - - - - - - -- -- - - - - --
- *Fee methodology set by Tri- County Building Industry Service Board.
_ - - - OCT 2 4 2003
CITY OF TIGARD
BUILDING DIVISION
CITY OF TIGARD • : 24 -Hour
BUILDING Inspection Line: (503),9-4175
INSPECTION DIVISION Business Line: (503)639 -4171 MST
BUP
Received Date Requested // � � 3 AM PM BUP
Location f '- / - 7 0 , n A—� - frj Suite MEC
Ste
Contact Person Ph ( ) PLM 3 - O O �
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
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof '
Other: j
Final
PASS PART FAIL f
PLUMBING
Post & Beam
Under Slab
Rough -In
- Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan /1
Other: 4:7
ly
PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply' Line
ADA {,
Approach/Sidewalk Date o Inspecto� Ext
Other:
Final • O NOT REMOVE this inspection record from the Job site.
PASS PART FAIL