Permit •
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00544
X 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/03
SITE ADDRESS: 12240 SW WHISTLER'S LN PARCEL: 2S103CC -09900
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 046 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: Install irrigation backflow preventer.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 10/16/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 10/16/03 $2.90
Total $39.15
Phone : 503 387 - 3875
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 RP /Backflow Preventer
Final Inspection
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
C /
Issued By• 1 i - Permittee Signature: 11 &J 1}Tr / /ei - i�dN
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Oct 14 03 04:26p dan edmonds 503 - 692 -0768 p.2
r Plu bing Permit AEtitetoiEt FOR OFFICE USE ONLY -
Received /� / Plumbing J M /t '1�/
Date/By: /4 l fr.S t. P No / 24 � 00-C /
City of Tigard Planning Approval Sewer
OCT 14 200 Da i r Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Dat&By:- Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -S -f °*..1 TIGA ., Post-Review Land Use
Internet: www.ci.tigard.or.us BUILDING DIV ' L Y .1 j
�� �t'`� Date/Ely: ,!'i' ° „ Contact - kg See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: t- Supplemental Information.
• :'_ • TYPE OF WORK • •• - ' • ~ ` 'FEE* SCHEDULE special information use checklist) '•
New construction Demolition Description I Qty. Fee(ca.) I Total
0 Addition /alteration/replacement lj Other. ' New 1= & 2 - fatnily.dwellings • , . _
CATEGORY OF CONSTRUCTION-- . -. " _ `c .. (includes :100• R. for each utility connection) - '
-1 & 2- Family dwelling ❑ Commercial/Industrial SFR (1) bath 350
SFR (2) bath 350.00 00
HAccesory Building ❑ Multi Family SFR (3) bath 399.00
Mas Builder 0 Other: Each additional bath /kitchen 45.00
• • . JOB SITE and LOCATION- , • - Fire
address: f o'�3'y0 f / , - sprinkler - sq. ft.: S Page 2
- Job site a SW c.vh.is t (�.� v �� ttei7tilities;. :-:•'. • . . •. -, '. •
Suite #: J BidgJApt. #: Catch basin/area drain 16.60
Project Name: W his`f'!er's LO ./G tor 4-1 (,, DrywelUleach line/trench drain
Footing drain (no. linear ft.) Page age 2 2
Cross street/Directions to job site: Manufactured home utilities 110.00
-C / 3 / 97 - ,°t° _ Manholes 16.60
Rain drain connector 16.60
_ Sanitary sewer (no. linear ft) Page 2
Subdivis on: W ivs - 1-t r LVC .k. I Lot #: 4 Storm sewer (no. linear ft.) Page 2
Tax map.'parcel #: (p _S - S - 6 - 5 - Water service (no. linear ft.....) Page 2
• ' ' DESCRIPTION OF,WORK .. • •' a Future or Iterri
Lcit'�SC d3cCe) Absorption valve 16.60 -
Backflow preventer 1 Page 2 a ?_ '
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1 16.60
�[� PROPliRTY OWNER - _ Drinking fountain 16.60
[] TENANT • ,: Ejectors/sump 16.60
Name: De r _ lmeS Expansion tank 16.60
Address;4,; . 30 ..u) &e d' a_LuOO lit, Fixture/sewer cap 16.60
City /Stale/Zip: LD e OS-w q/Z)..3..c Floor drain/floor sink/hub - 16.60
Phone: Fax: Garbage disposal - 16.60
11PPLICANT ' Hose bib 16.60
laCONTAC PERSON - • Ice maker 16.60
Name: Ell e_ii Sp O.rra-t_C Interceptor /grease trap 16.60
Address: I - 0 CU- YY1 tyly R D Medical gas - value: 5 Page 2
City /Stat - TLuU L1 1 A., 0 1 e. 97 ( a_., Primer 16.60
PhoneS03 (o4.)- - Sr'(� S 1 FaxSaa (oC3 a- O7/o 8 Sink/basin/lavatory (commercial) al) 16.60
E -mail: • Tub /shower /shower pan 16.60
' ' -.. ,- :CONTRACTOR . Urinal
�;, 16.60
Business Name: L y SCo. O 1 �.sldln - G water closet 16.60
Address: l'>-00 , Water heater 16.60
�v 1' Yll Shin l Other
City /Statr/Zip: nAcu.a.#- -6 t. 4-7c o a-- O the
PhoneS'c.3 (tRa - 591 S Fax3)3 (A4d - 0'710,{ .Plumbing•Perinit Fees * - , :..27„S" - -
CCB Lic. #: "7.Dy Plumb_ Lic. #: Subtotal $
Authorized i' N Minimum Permit Fee 572.50 5 .� (o �S
Sigaatu
Authorized
+ l L. Dat fO L f � 03 Residential Backflow Minimum Fee $36.25 -
Er/ S--pat- Plan Review (25% of Permit Fee) 5
C � ` [ - State Surcharge (8% of Permit Fee) $ e7 , 96
(Please print name) TOTAL PERMIT FEE $ 35.. I
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
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location l:Z2-4 D Ljt) Lvi S S 1-rx - Suite MEC
Contact Person Ph ( ) Cog z 99 q$ d - O 0 SSG
Contractor Ph ( ) SWR
BUILDING . Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain - ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam , S � ° w C�
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other: -
Final _ /
P FAIL
UMBING
Post & Beam dip/
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain.Drains
Catch Basin / Manhole
Storm Drain
S :,erPan
•� F
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 ❑ 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