Permit CI TY OF TIGARD PLUMBING PERMIT
�, DEVELOPMENT SERVICES PERMIT #: PLM2003 - 00600
X11 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/20/03
SITE ADDRESS: 12305 SW THORNWOOD DR PARCEL: 2S110BC 05100
SUBDIVISION: THORNWOOD ZONING: R -
BLOCK: LOT: 022 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 11/20/03 $36.25
STE 100 [TAX] 8% State 11/20/03 $2.90
LAKE OSWEGO, OR 97035 Total $39.15
Phone : 503- 387 -7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 692 5945 RP /Backflow Preventer
Reg #: LIC LCB: 7804
PLM ALL PHASES - PLL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issued By: Permittee Signature: / ,
Call (503) 63 -4175 by 7:00 P.M. for an inspection needed the next bus s day
Nov 19 03 02:47p dan edmonds 503 - 692 -0768 p.2
FOR OFFICE USE ONLY Plumbing Permit Application
Received Plumbing - Q� � ,,/1
RECEIVED C E I' E D Date/By: Permit Notl u t 1 p�Q�j�lj - 00 0
CI t)� l<d L v C V V Planning Ap Sewer
`.7 g Date/By: Permit No.:
13125 'SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 NOV 1 '9 2003 Date/By:. Permit No.:
Phone: 503 - 639 -4171 F9$. Q O Post- Review Land Use
VJ' 1 i pq SLR Apof, . , ,, Date/By: Case No.:
Internet: www.citigard. . '
ry I O i e� W C ontact Antis.: ' El See Page 2 for
24 -hour Inspection Reques�4 Name/Method: Supplemental Information.
. .'.. TYPE : OF WORK . ... - 1-'1;,' . ; : :. ;..: ••_.: :,.... ' . ` FEE *.SCHEDULE (for special ' informa _ tion`Use:ctiecklist). ' .;
N. New construction ❑ Demolition Description I Qty. 1 Fec(ca.) 1 Total
❑ Addition /alteration/replacement ❑ Other; ` New 1 =_ &`.2 family, dwellings : •
:. ..:. CATEGORY.OF C _ ONSTRUCTION: - fwudesa00it. for each utility:connection) ".
I & 2- Family dwelling ❑ Commercial/Industrial " SFR (1) bath 249.20
Building SFR (2) bath 350.00
Accessory g - ❑ Multi- Fa7nilY SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
"JOB SITE :INFORMATION and LOCATION. -f Fire sprinkler - sq. ft: Page 2
Job site address:1Q3US -S to 7TI ieycad DI pt;', . :.'':: ` : °:': : - :,. • .Site:Util'tie .. ,
Suite #: I BIdg./Apt. #: Catch basin/area drain 16.60
Project Name: /7le?Y11 /.( Coe Drywell/leach line/trench drain 16.60
( v , Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
S LL) 4 1/ IV-4-7 tit Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivis ion '.`Thpyn ( y 004,, j Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Lo S S /5(00 ` Wat service ) Page 2
Water serve ( n
o meat ft.
DESCRIFTJON OF WORK . Fiittire or Item'
i d-If d c pL Gee tOu) CL e31 � Back Absorption valve ag 2
�� C flow preventer t Page 2 a7_ s'S'
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
;PROPERTY.: .: [ID Ejectors/sump 16.60
Name: Doi /y) iL.S.S i _ i k y ..s Expansion tank 16.60
Address:4- 30 &u &ate! t).,00 d> Fixture/sewer cap 16.60
City /State /Zip: t 04-wt cno.a Floor drain/floor sink/hub • 16.60
Garbage disposal . 16.60
Phone: Fax: Hose bib 16.60
;: RAPPLICANT •••...,.: ..- 1 tCONTACT•PERSON 7 .-'..`:''' Ice maker 16.60
Name: al la) Spa-mil-0 i -0 Interceptor /grease trap 1 6.60
Address: / �.O 0 CIA) Yh tCv, y (RD Medical as - value: $ Page 2
City /State/Zip: - n-uct. �(lr A. C) I . . J 970 (o Primer 16.60
Roof drain (commercial) 16.60
PhoneSo3 (o9Q- - Sri4S J Fax:S63 bpi e:_- 076g - Sink/bhsin / lavatory 16.60
E -mail: • Tub /shower /shower pan 16.60
..... :':_:CONTRACTOR:: _:: :, :; _ Urinal 16.60
Business Name: (O. 4. c tx 0 re � - c, Water close 16.60
Address: t>? Oa �J Water heater 16.60
s� h� �[fm lam. Other.
City /State /Zip: ,...f g_. Crean dL. Other. 1
Phone:Sh3 (ia - S4 Y S• FaxS° (DC(d 617141 . Plumliing. Fees *: , '- 'bZ ?;SS ... ,
CCB Lic. #: `7y Plumb. Lic. #: - Subtotal J S
Minimum Permit Fee $72.50 S 2 s
Authorized Residential Backflow Minimum Fee $36.25
Si y gnatur - i -m a- -a C- Date :i i iigi1 Plan Review (25% of Permit Fee) $
E j I en Spar re -L3 State Surcharge (8% of Permit Fee) $ Q. . '7 6
Spar
print name) TOTAL PERMIT FEE r $ .‘q, ! S
Notice: This permit application expires if a permit is not obtained within All 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.
•
CITY OF TIGARD , 24 -Hour - f 7 .
BUILDING Inspection Line: (503) 639 -4175 r:
INSPECTION DIVISION Business Line: (503) 639 -4171 / ' MST
BUP
Received Z /2_4 Date R ested //2 3 /0 4 A `,PM �` _ BUP
Location / 2 3 0 /1-C%Z"(/iit t (75 Suite A 2 Z MEC
Contact Person C - Ph ( SUS (6 92 ' , ► 3 LZ la On
Contractor /
INIIr ∎ 4- ' ,. l Ph ( ) i SWR
I
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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING 1 r _ _
Post & Beam
Under Slab ,
Rough -In �� 2/ �iJi� 1
Water Service
Sanitary Sewer (111'.
Rain Drains
Catch Basin / Manhole
Storm Drain
Showery a jek
r: 2.�L
Fi
AS PART FAIL
HANICAL .
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 0 Please call for reinspection RE: Li Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date / 3 Inspector Z
Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL