Permit CITY TIGARD PLUMBING PERMIT
4 �'' DEVELOPMENT SERVICES PERMIT #: PLM2004 - 00145
`'` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/6/04
SITE ADDRESS: 12350 SW KELLY LN PARCEL: 2S103CC -08200
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 029 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 ST [PLUMB] Permit Fee 4/6/04 $36.25
STE 100 [TAX] 8% State Surcharl 4/6/04 $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 RP /Backflow Preventer
Reg #: LIC 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: d 41 ,� � i _ � _ _ / „
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Apr 05 04 03:03p cl t li\c 3 503- 692 -0768 p.2
umb rig Per ini NP l •
bgtII :FOR OFFICE USE ONLY -
Plumbing
NPR -- Received Plu R U Datr/By: Permit No.P ( t• - ‘ , 01 1 1,c - ciI0 on Ci'y of Tigard F TIGA -- Da Approval Sewer
Tigard, Oregon 97223 gILD
BUILDIN DI 'f 1
Hall Plan Review � Pt Na.: /O �
5
Pcmit No_ls -r ?, ,l- •
Phone: 503 - 63914171 Fax: 503 - 598 -1960 ; Post - Review Land Use
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Internet: www.ci_tigacd onus . , . is �,
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s' may:
Case
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24 -hour Inspection Request 503 -639 -4175 "" Na Iris -: El sec Page 2 for
Name/Method: Supplemental Information.
..:. :: -: : ,:.:..: . PE :or- WORK° : , c : : : a:
New construction 0 Demolition CHSD
S ( for�ipeciati' inforniatlba se`u:checklisi):';:'.:.:,
_ Description wel
Addition /alteration/replacement
0 Other: : ; - � H� � } vY=:�faitait j dwe! � ings : CATEGORY ' - . ' =.' (includes _OF:CONSTRUCTION ;: - • .. .. ,. . ,,.. - - �l1 daao t :�foc earai ' d vT ij�. `' ' _ , - ..... .
I dwelling _.:,,,_::.:: S 2 : ,:
N .
� 2-Family g [] Commercial/Industrial bath 24920
& 2 -Famil ccesso Buildin Multi-Family FR (2) bath 350.00
El Each additional bath/kitchen 45.00
Master Builder : Other: Y SFR (3) bath 399:00
. Job g `JOB. SITE INFORMATION and LOCATION:::::: : Fire sprinkler - sq. It: Page 2
site address: % 5 (, „Su.) t^N :::1 -,-_ 4.::,;:. - •
Suite #: lCt,��' �'1 � . , -, .::, • :..:. •;:•: .. :.,.: ;- ... ':SYte.,Utilities.; :::.; : -:: :::�;� = ::; , • , : , :-.:4:. , : - : , .± ., .:
.
BldgfApttk Catch basin/area drain {'7;; 16.60
Project Name: Ll% hi t7 s U) GZ c Lb Z y Drywell/leacie line/trench etich dr 16.60
Cross street/Directions to job site: Footing drain (no. linear ft) Page 2
Manufactured home utilities 110.00 o
S L.d ' Z/ / < Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no_ linear ft.) Page 2
Subdivision: IX cry, sjles7s W C -k I Lot #: mi=l: Storm sewer (no linear ft.) Page 2
Tax map /parcel #: f s
:.: DFSCRIPTdON
o S S _
:nt.OF,W . ,.. -, . r�e.o _ • Water servile (no lin ear ft.)
Landgc�c, rea.rae{-at C Oi ce) B meter ' ( a 2 `1 ...:. < 5 .:
j Page 2 ,�.'�- �'
Backwater valve 16.60
Clow washer 16.60
Dishwasher 16.60 '
`Cj- PROBEItTY,UVYNER Drinking fountain
0 TENANIT = : ;; ; .. < . . .. :; : cr_ _ , :: ' 16.60
Name: D art ! Y (5Y'Ls.,s.A.41-e.. kierro !,S Ex jen tank 16.60
Expansion tank 16.60
_ Address: { 36 Su? '& ,uoo et) Fixture/sewer cap 16.60
City / State /Zip: Lo.1e 4 i.i � e. 0 esi ct7O35 Floor drain/floor sink/hub � - 16.60
Phone: I Fax: Garbage disposer . 16.60
APPLICANT :` :,i '&CONTACTPER.SON: _ - V -_ r .,
Hose bib 16.60
Name: Ice maker 16.60
Elie") �f" Interceptor /grease trap 164
Address: I .O 0 ‘.W f'Y1 Ef1Ytt J it} Medical gas - value: S Page 2
City /State/Zip: — -
GLQt 1 C) t 974 Co a.., Printer 16.60
PhoneS63 (off - S i y S i Fax: 503 1 4 9 3 . - 0 7 E 0 Q Roof drain (commercial) 16.60
Sink/basin/iavarory I6.60
E -mail: . Tub/shower/shower pan 16:60
. ...: .:.: .
. .. .. ...CONTRACTOR:. ;: ° ::::.: • '- - Urinal 16.60
Business Name: La.. �dSca p -��, �,
� j e , , Water closet 16.60
Address: I. D--D -O o &_A-1 hn r �mrvi _ water heater 16.60
City /State/Zip:' ;., wa(a— Other:
Phone f 9 SQ y s F axs?3 (09A o �� . .. . . . ,., . I!3uiabiu 1
CCB Lic_ #: ??b' .Pl i; Permlt *•:° i x1:55 ... .
clmb Lic, #: Subtotal S
Authorized At. Minimum Permit Fee 572.50 5
Signaturg,-/� -L � Date:- (slog . Residential Backflow Minimum Fec $36.25 3 to • ��
El I er) U �ar I � (Please Plan Review (?S% of Permit Fee) 5
State Stucharg a (8% ofPe anit Fee) S 9 r
Notice: This Permit application expires name)
if a permit is not obtained within TOTAL PERMIT FEE S
3 / S
158 days after it has been accepted as complete All Mw commercial buildings require 2 sets arplans with isometric or
- riser diagram for plan review.
--
-- _ -- *Fee methodology set byTri- County Building Industry Service-Board.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
Q BUP
Received 9? 3 9 Date Requested �!Y � AM PM BUP
Location / Z 5� /C 0 Suite 1-7` 2 -9 MEC
Contact Person ( 7 t ° ,0 A4A Ph (_,S1)_. G 2 ey PLM 1
Contractor /..46 -Cf C Ph ( ) GWR)
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
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS PART FAIL
PLUMBING
Post & Beam L/VI:,-
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower • n
•
'! PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
F 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 El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector V Ext
Other:
Final DO N s'T REMOVE this inspection record from the job site.
• PASS PART FAIL