Permit A, CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00128
EJII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/29/04
SITE ADDRESS: 12350 SW THORNWOOD DR PARCEL: 2S1106C -06000
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 031 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 3/29/04 $36.25
STE 100 [TAX] 8% State Surcharl 3/29/04 $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 : 503 692 5945 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: i /
/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b i ness day
Mar 29 04 11:50a dan edmonds 503 -692 -0768 p.2
A.
.. Plu Permit 1i� n Received FOR OFFY Plumbing " O \LY ; may .: � .. Dale/B . Permit No. '��1o1v 1 av
City of Tigard � ��4 Os s Approval Permit
No.: // 1 -00 - Off) i
13126 SW Hall Blvd. A hS '4 (� Plan Review Other •
Tigard, Oregon 97223 ,", 1\ 6 PR Dare/B .. Permit No. ii, % .* ; ' ° - •�,
Phone: 503- 639 -4171 Fax: 503 r-you D � v '„A,4!! 44, . s r, Post-Review " ew Land Us
G, I
Internet_ www.ci.tlgard.or.us t DAN d� + I Contact ]iris.: i see Page 2 for
24 -hour Inspection Request: 503 -0175 "` """ Name/Method: Su . , lemental Information.
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; :TY!'E'OF'WORK :� - :
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S , , -:: . ; ::-.FEEt . SCI3EDUI�E( forspeeialiufor "viation.tesectieeklist)': . •::
New construction Demolition Description Qty. Fee ( ea Total
)
Addition/alteration/replacement El Other `�' , : Nei 1 & 2-fam ly dwellings
. `.:CATEGORY,OE CONSTRUCTION:.. ::ms : :. ?:- :':. :,(iitdudes 100' i!:'foi eies utility`connection).':;
SFR (1) bath 249.20
1 & 2- Family dwelling Commercial/Industrial SFR (2) bath 350.00
Accessory Building - E. Multi- Family SFR (3) bath 399.00
0 Master Builder - ❑ Other: Each additional bath/kitchen 45.00
: JOB SITE'INFORMATIOMand LOCATION '- Fire sprinkler - sq. ft.: Page 2
Job site address: / 23SCo .SU) Thirrll ts2C r. bt& . .:.:. r.- - . ai7trtiliatts:. • - . -
Suite #: ll BldgJApt.#: _ etch basin/a ea drain 16.60
Project Name: - heli a? 000- L.c`T ►'
Drywall/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 11 0.00
SO ii l .-ti RO Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft) Page 2
Subdivision:' lr y y) LL)CC.a., ( Lot #: 3/ Storm sewer (no. linear IL) Page 2
Tax mapparcel #: (,, S S 8 _Water service no linear art Page 2
reo:
.: : : DESCRIPTION'UF.WORK : ';': :: '-: - Absorption valve 16.60
L1LfdSCaf) G ZCLCJ,GhOCL) LtC. 3 LC Backflow preventer / Page 2 a'?. 5S'
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
'S,PROEERTY.OWNER•: . { LI: TENANT. '': ` ' : : :.' :; V.:-'!:1",;; Ejectors/sump 16.60
Name: t_tret m OY/ 5 ill- . 1 k'w C.S Expansion tank 16.60
Address:4? 30 Sus) (?ct E _v_loo CU Fixture/sewer cap 16.60
City/State /Zip: L•U•'1e_ O4- w+erj6 Q 2C . Floor drain /floor sink /hub - 16.60
Phone: Fax: Garbage disposal _ 16.60
Hose bib 16.60
`)APPLICANT ' .'. `: _ l CONTACT:PERSON' . Ice maker 16.60 _
E.
Name: 1 Cr1 .pO.rre -up Interceptor/grease trap 16.60
Address: I i 0 C40 f')R C.. p.D Medical gas - value: S . Page 2
_ City / State/Zip:Tb ald5ht C' rY K. 9 70 (v � - . P r u ner 16 _
Roof drain (commercial) 16.60
PhoneSa3 (o• - 99 LIS j FaxS fog a.- 076 g Sink/basin/lavatory 16.60
E -mail: . Tub/shower/shower pan 16.60
_:•• .;; , :::::::CONTRACTOR - .... .. - r_. Urinal 16.60 •
Business Name: Lr�dS Q r
Water closet 16.60
Address: t? - Oo C1� �JJ ay -tn.(.
Water heater 16.60
S•w h11 � ►�• Other
City /State/Zip: i...a /2_. ql Qtfl a- other: •
•
Phone (AI - 3 (.dM - il •-: :.�,: ., ' ;Ploaitiini ;Permit - Fei *= :. ' •!J S5 .
s'u OIL'S S Faxes 0 . -, - - .
CCB Lic. #: - 7 Y-I , Plumb. Lic. #: Subtotal $
Fee 536.25
Minimtan P ermit Fee $72.50 S 3(0
Authorized / e ,,� �,f , / / Minimum -
Signature G 7 JIL'l� LYl� Date/ � l v t Residential Backflow Mir- Plan Review (25% of Permit Fee) , S
El! err Spar ra l State Surcharge (8% of Permit Fee) S e2 .
(Please print name) TOTAL PERMIT FEE S 39. / 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 plate 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 10 % 2- 24 Date Requested �'q'�7`' AM PM BUP
Location / 23 n". , �^ oe Suite 7 MEC
Contact Person , Ph ( ) 6 ?2 — OD/ Z
Contractor .D.ep OZ Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain / r6 d� 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 T FAIL
P
Po : eam
Under Slab
Rough -In
Water Service
Sanitary Sewer '
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower P n
Other:
Final -F
//PA PART FAIL
`ft TE
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final J Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: J Unable to inspect — no access
Fire Supply Line
ADA �/ 6 I
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL