Permit CITY TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2003 -00522
c � J -' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 12240 SW THORNWOOD DR PARCEL: 2S1106C -05500
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 026 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
Issue y: �7/1� J I . ;I�'� Permittee • Signature: �0 ;? %frF /a.4.�/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next • usiness day
Sep P'l 03 02: 46p dan edmonds 503-692-0768 p . 4
. *
Pluthbing Permit Application Received ,.% FOR OFFIC USE ONLY
Plug II
City f Tigard RECEIVED
• Date/By: Y 1 "9 a3 Al/ Permit No.: 1..-/49605 g.
Planning Approval Sewer
Date/By: Permit No.:
13125 S lHallBlvd.
)L 2 9 2003 '41. Plan Review Other
Tigard, regon 97223 Date/By:. Permit No.:
Phone: 03 Fax: 503 .. . ., : Post Land Use
Date/By: Case No.:
Internet: www.ci.tigard61E/ OF TIGARD .1„. ..i. i I
Contact
r: I el See Page 2 for
24 tion Req'ilat.C5M63041W ' --'
Inspec Name/Method:
/( I Supplemental Information.
' • - :'h '::: TYPEOF WORK:: ' ;'• • • ' '.::f,•;' •:. :12,, ..','• :'•:,"'':. FEE,' SOREDULEffne,Spead infotiOnCheeklia)
L_NNIew construction D Demolition Description I Qty. I Fee(ca.) I Total
0 Addition/alteration/replacement 0 Other: , .....1. ! • :;:i.:,;,..:, ,ff '.' Niii. i .,- :.• ?:1:. •...j..' :
CATEGORY OF CONSTRUCTION ::, ,:••••.,-, :, ,-•.::: (inekides.1110 ft. (Or each nib connection)
: - ,:s.:'t:]: , .. - :: - ......... 7 .:('. ',k.
SFR (1) bath 249.20
• n1 & t-Family dwelling 0 Commercial/Industrial SFR (2) bath 350.00
0Acce4sory Building . 0 Multi-Family _ SFR (3) bath 399.00
0 Ma4er Builder [3 Other: Each additional bath/kitchen 45.00
•'.110B and LOCATION •"....-..... Fire sprinlcler - sq. IL: . Page 2
• Job site liddiess: h...1../0 SW 71-,cr et Dr . r•-•;:!'::•-:: :: '., ..,.,',::: v.r,': : ....:Sitittilitiroi- •:,:'•-:..-;;;:.; : ..,::: ::':', ::
Suite #:
i i I Bldg./Apt.#: Catch basin/area drain Drywell/leach line/trench drain
16.60
16.60
Project ame:Thorru)..)00 cL LOT as, Footing drain (no. linear fl.) Page 2
Cross s eet/Directions to job site: Manufactured home utilities 110.00
tta. 8 1 ( 04770 14 Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) _ Page 2
Subdivis WO cx 1 Lot #: ace, Storm sewer (no. linear ft.) Page 2
Tax ma p
Water service (no. linear ft. Page 2
to .. 8ce=, :.:: :'..:.:;; :" :: :;:':::•ii;;; :.:, :..T:Fiiitiireiii Reni':: , _i: :•: .f : : • .;:.; , .:, ..,.::.,
: :•;.•::::.: '•'. ' • . -: . , DESCRIPTION OF WORK
LartetS ape_ *Jaccc-Mu) et CA) z c)
f
arcel #:
Absorption valve
Backflow preventer i Page 2 2.-7.ss
Backwater valve 16.60
.-
16.60
I Clothes washer
16.60
Dishwasher
Drinlcing fountain
16.60
16.60
PROPERTY:OWNER :: •:::••. I: 0 ,TENANT: F.' .:' :'•::' -:::, • . : :;: .! .• Y Ejeaors/sump 16.60
Name: bori m 0 s.S141e, kin-rieS Expansion tank 16.60 '
Acklress4,2 30 S..t0 •&a4..it.c00 0 cC) Fixture/sewer cap 16.60
City/State/Zip: 14-fie_e. 0 Q.703.-C' Floor drain/floor sink/hub : 16.60 •
Garbage disposal . 16.60
Phone: Fax: Hose bib • 16.60
7'1SLAPPLI CANT: ' ::. ...', ; ::::!... "UCONTACZPERSON ::: :" Ice maker . 16.60
Name: 61 icn S.po-rmo Interceptor/grease trap 16.60
Address:! D..-C) 0 <-L n'i RD Medical gas - value: $ Page 2
City/Sta :e/Zip: mittlast 0 R.. 9 7 0 (6 a__,
Prima 16.60
Roof drain (commercial) 16.60
Phone o3 (09.2.. - 9:1 I FaxS log d.- O% Sink/basin/lavatory 16.60 _
E-mail: . Tub/shower/shower pan 16.60
' .7 S '.. ...: ::..: .......; ,. :CON ::, .;: '.::;:: Urinal .
16.60
Busines1 Name: i_o_rd...CaLpt._ 0 re. - r - r1 c.,, Water closet 16.60
Water h660
Address I?-O0 SW SW I'll t.i.CiAny et). othei eater 1.
. _
City/Staie/Zip: -t R_ - 4 - 70(0D- Other:
PhoneSt3 (lj - FaxSD3 Co9.1 - 0'71e k .' : - : . 7. , '. ,. ?"';':.':.::': '..':::::;Pluniliing:Perinit Feiik!
CCB Lic. #: '71O/ Plumb. Lic.#: Subtotal $ .
Minimum Permit Fee S72.50 $
Authorized d , ,
Signa/rZt 4.)all.../ Date ieW°3 Residential Backflow Minimum Fee S36.25 •-- ' '''''') .
• Plan Review (2_5% of Permit Fee) S
Eli e-fl _ A ar rata State Surcharge (8% of Permit Fee) S e.1 . /15
(Please print name) . TOTAL PERMIT FEE $ .:3 / 5
Notice: Th permit application expires its permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days aft it has been accepted as complete. riser diagram for plan 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
BUP
Received Date Requested !/ – / 7 AM PM BUP
Location 1 2.D. 1 -/-0 "7-2-1 e -rte'^) O Suite MEC
Contact Person We-feet Ph ( ) (P c ).2. — �a-
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: _ SIT
Post & Beam �0.G/( �/ o w �X v i 02-
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
•
Fire Alarm �'/
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
Other:
Fi
PA 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
ADA
Approach/Sidewalk Date _ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL