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Permit
.l . CITY OF TIGARD PLUMBING PERMIT �1 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00370 r� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/30/2003 SITE ADDRESS: 12265 SW THORNWOOD DR PARCEL: 2S110BC -TS024 SUBDIVISION: THORNWOOD ZONING: R -7 BLOCK: LOT: 024 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: back flow preventor FEES Owner: Description Date Amount DON MORISSETTE HOMES 4230 GALEWOOD ST [PLUMB] Permit Fee 07/30/2002 $36.25 STE 100 [TAX] 8% State Tax 07/30/2002 $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 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: I Permittee Signature:. AA / _ ,, Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin • ss day • Jul 2 03 02:36p dun edmonds 503 - 692 -0768 p.2 Flu' F OR OFFICE USE ONLY _`.: Fi. jI i ng P erm it A pp li ca un LY ; ` . Received � � Phmrrburg ,,//)) ,,,,,,,, ((�°��`� Date/By: ' Permit No.rl 1 a � 3- imp 37c) Cl of Tigard QeV \ Approval sewer 1�i ,, � Date/By: PetmitNo.c 13125 SW Hall Blvd. 1op3 Plan Review .. Other • Tigard, Oregon 97223 Datelt3y • Permit No.: �� Pod -Review Land Use Phone: 503 - 639 -4171 Fax: 503 -598- 9V-c� ;A,, , : -1 . (,i Date/By: �No. Internet: www_ci.tigard.or.us N(0 . ' J j ( IN � � 01 „ c - _ � Caatact • • Jutis.: El Page 2 for 24 -hour Inspection Request 503-6-J NamefMetlmd: I I Supplemental Information. -. -TYPE'OF WORK'':::. -:: ? V: • 7:: :;',:, ; FEE'' SCHEDULE'(for:special in)'ormation Ilse cheddist ew construction ❑ Demolition Description I Qty-.7 Fee(ca.) I Total El Addition/alteration/replacement 0 Other. < ` - 24anuly;dwegings '= ,:'':'• . . elud too ft'_ o ATEC:oR�I OF .0 ONS;IRU.CTTON. , : - :, ... . . . • :•°' :.: :� "'al o � ; .� .�... : . . . _ dwelling SFR (1) bath 249.20 lill MI I. 1 & 2 g ❑ Commercial/Industrial SFR (2) bath 350.00 []Accessory Building ❑ Multi - Family SFR (3) bath 399.00 0 Master Builder ❑ Other. Each additional bl 45.00 r `:IOB SrrE1NFQRMATION.aitdLOCATION '.::.`: ::: `': sprinkler Fire sprin - sq. fL: Page 2 Job site address: j - S SILO i7,er'I ?wcrict ,Dk - . _ :.::.. :Site:Ud6ties _ . .. - . .... Suite #: 1 BldgJApt. #: Catch basin/area drain _ 16.60 Project Name: 7 7101. 7 tit: �rr,L t i3y DrywelU[each tine%rench drain 16.60 Footing_dtain (no. linear fL) • Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 1-0 64A-0 Manholes 16.60 `' l Rain drain connector 16.60 Sanitary sewer (no. linear fL) Page 2 Subdivision: 7710 7ZZJt'OcL. Lj #_�! y Storm sewer (no. linear R) Paget Tax map /parcel #: GeS 13 0 - Water service (no. linear R) Page 2 re or - .. ::.: -• • .,,...:., DESGR LPTION :OI`WORIC�.:,;: -' r : , . .... . . . . . . . ..... _ , : , , :.;.; .. ;:.; ...� Fiitit> .. ,,. -.Item : �::: _ Absorption valve 16.60 ( - J f)c(SG • f/ /1 Lzt7ax Bac kflow ca - `I preventer 1 Page 2 2.'7. 55 f30(-#C '7irYLL) cte..vic Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 OPERTY.O- _ . Drinking fountain 16.60 WNEIt::.:y:. •.� TENANT Ejectors/sump 16.60 Name: Del') f YI G*YJ - e //->- r`..S Expansion tank 16.60 Address: 2 4) 3o 4 (xe, (,z 46-64 Fixture/sewer cap 16.60 CitylStatelZip: if-2- 6S ctrcgo o /2S/ 703 y Floor drain/floor sink/hub 16 :60 Phone: Garbage disposal . 16.60 Fax: ^ Hose bib PLICANT"• , ^.':';. : -,'• `:;:';:` • ' 16.60 CONTACI"1PERSON:' <: i ranker 16.60 Name: - 1 /e.r) 4par -EL) Interceptor/grease trap 16.60 Address: /) S W Al Vevl I'-(j Medical gas - value: S Page 2 M j City /State/Zip: A -Las , 5 /_, -9 7.E9& Primer 16.60 Roof drain y . Phone:5t3 (.094 - 5915 I Fax:S - [)76 p• Sinnk/basin/lavatorl) 16.60 � 16.60 E - mail: Tub/shower/shower pan : 16.60 . . . ..CoNTRACTQR ` " :. _. _ Urinal 16.60 Business Name: Lezi ins e. c) d .,1G Water closet 16.60 Water Address: 4.1 . F6 7 fh vs/031y /2b Other- h z . 16.60 City /State/Zip:Watt/Wlrt- OR-- 976 ((a_, Other. - PhoneS ©3 ipqa. 59q E Fax: 563 io9 - c - w g .. . _'vei nitT ;` ... CCB Lic. #: ,- 1 et) cc Plumb. Lic. #: • Subtotal 5 Authorized - Mininami Permit Fee $72.50 $ Sign /D -7/02 J Residential Badtflow MinimumFee. ...T6 0 . .. f /ems SeaJ r- �t 3 Plan Review (25 of Permit Fee) .. $ State Surcharge (8% % of Permit Fee) _ $ , '16 (Please print name) _ . TOTAL PERMIT FEE S .3 `1- L S Notice: This permit application expires If a permit Is not obtained within MI new commercial buildings require 2 sets of plans with Isometric or 180 days after it has been accepted as complete. riser diagram for plan review. - *Fee methodology set by Tri-County Building Industry Service Board.