Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00296
J 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/2004
SITE ADDRESS: 12062 SW WHISTLER'S LP PARCEL: 2S103CC -12500
SUBDIVISION: WHISTLER'S WALK NO. 2 ZONING: R -4.5
BLOCK: LOT: 072 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: Backflow preventer install.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES INC [PLUMB] Permit Fee 6/29/2004 $36.25
4230 GALEWOOD STE #100
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchari 6/29/2004 $2.90
Total $39.15
Phone : 503 387 - 7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
P RP /Backflow Preventer
Phone : 503 692 5945
Final Inspection
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
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: O
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jun 28 04 0 1 :54p dan edmonds 503-692-0768 p . 1
. .. . .. ., , FOR OFFECE•USE ONLY.
• ...-.:. . -,..
( Fkanibing Permit Application Received Plumbing
DatelBr. , / e , ,, 3 , ( aif fi, Sew Pan* No.: 72-0,3/ , A
P
City of Tigar* ; , --0 \ lanning
Dateilly: er
Permit No.:
13125 SW Hall Bbre0 1 .* Plan Review Other
Tigard, Oregon 97223 - Dak/Ely... Polak No.:
' gq 4\ 4411ii
Phone: 503-639-4171 Fax: 50,31 Si3
,. . .., - . _ _ .:-.. ,- :.,.; , . ( . . Post-Review
Datc/119: - I Land Use
Case No.:.
Incemet www-ei- ' c)\ Ll . .i I .. CAL Contact . inris..7. I HI See Page 2 For
24-hour Inspection Request ''--- - - - - • Nanadbfethodt r/q Supplemental Information.
e;k.‘‘
..-:.:: .. -,-:..-::-..=,--:,---;: WORK - '..-...,.. • ,,. :-.•::;..-:;-...,-, -.7-: tfairniitie7cheddliff • ;' .,,
E I,Vevi construction I 0 Demolition 1Deserription Jr Qty. 1 Fee(ca.) I Total
Addition/altenitionheplacement 1 El Other: -..:. i---.--' ..,::::-. -,izkiiiit:.41.4ny:thiitrlags"-:
1"- '..- oiiriasiarY.:- .- - -.:.- •"..• ,
CATRGORY:OF.CONSTRUCTIOX....:::a;:. t)::-.. SFR (1) bail 24920
INIK& 2-Family dwelling E1 Commercial/Industrial • SFR (2) bath , 350.00
_DAceessory Building . A Multi-Family SFR (3) bath 399.00
0 Master Builder Other: _ Bads additional bath/kitchen 45.00
:JOB SlYEINFORMATIONliird Foe sprinIder - sq. fL Page 2 ,
Job site address: / . C.) .. - S - c..1_ , Leh / 1,i ci Lail €. "!': ; .-**::':::- j , ':'•' - ' - : - .- ' -1 :::: - . - ' . , .... -- ' - •
Suite #: J Bldg/Apt.#: Catch lserh;farca drain '
- Drywell/leach line/bench drain 16.60
16.60
Project Name: W L j :::: L L.OT '7 ---- . Footing drain (no. linear ft.) Page 2 ,
Cross street/Directions to job site: Manufaconed horny oblides 110.00
S 123 1 9..- i S T -).-'<-'_'_ Manholes
16.60
Rain drain connector 16-60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: i_■22 t_.:.) Its. j Lot #: ' D...._ Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) age 2
Tax map/pareel #: (..,E EL E" 6. S ' ". ......-.:- :z f":;w1 ' •' P *.st:'
'':- .......- - • • ' - • ...':::DESCRIFIIION.OF<WORK.: ',::::;-::';'-'• : ."-. '. 'F-f:;:• - r .
Absorpticor valve - 16.60
1-4.1"big Cap e- "ga.C.-/C Gfe.. Barkflow preventer i Page 2 .2.1- ss
Backwater valve 16.60
Clothes washer 16.60
- Dishwasher 16.60
Drinking fountain 16.60
1SLPROPERTTOWNEle-.:- -. . - ;-;.:-:-..-...,::....:-..,:t:n--2,:f.,-ii, Eiectorsfsnmp • . 1610
Nanie : EMO2a1 33‘.....___ Expansios' etas* 16.60
Address:4a 30 Zit) . &r.1 GO Fixture/sewer cap 16.60
City/State/Zip: 1,04 . 04 g7C13< Floor drainftloor sink.4mb .- 16.60
anbage disposal '
Phone: 1 Fax: Hose bib -
16.60
..•--likCOPITACriPERSOltV-'1::;5' _ 16.60 Ice maker 16.60
. _
Name: al Jr ( Spar7ia0 Interceptorigrease trap 16.60
Add ress: / p.......) 0 .Cu a nnysiont.4 .12.0 Medical gas - valu= $ . Page 2
Primer
City/State/Zip: - rt.kalastuk, 0 lc' crio to a, . 16.60 Roof drain (mann:read) 16.60
PhoneS33 totia. - 9i 45 1 Fax IA a.- 076 2 Sink/basin/lavatory 16.60
E . Tub/shower/shower pan 16.60
-:y-coPrrinterost. -.. : ::-:::::-.1/4-:1 Urinal 1610
____
Business Name: Lii_rAccapft_ 0 rtidY‘ -r-fle_) Wao:r closet _ 16.60
Water beater • 16.60
Addluss: 13-D-00 SEA-) rn 1 4..anytj len_ Other: .
,
City/State/Zip: - 6R- crboram- Other .
Phone a3 wia-sizois I Fax5D3 Ogol - Oglo 8' .. - -:,.-]:j:'?"-t'..-:-v:-':-
CCB Lie_ #: - 7er1.i 1 Plumb. Licit: Subtotal S
Maim= Permit Fee $7250 $
Authori d , p Residential Backflovr henirnum Fee S36.25
Simannx...----r-t i -.' 4_40GL-1.A-ea, DatmLP id. P10--1
, , ) Plan Review, (25% of Pernik Fee) S
Eli en kyar art 3 - State ' . , - - • : 13 o(Pernik Fee S - . "` A
(Please print name) TOTAL PERMIT FEE S _39. / 5
Nod= This person application csqpircs it a pormit is not obtained within AB new commercial buildings require 2 sett or plan wit isometric or
180 days after Et has beers accepted as complete- riser Swans for plan review-
- *Fee methodology set by TN-II-County Building Industry Service Board.
.16:-C31
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 7 4-( Date Reques ed �$ AM PM BUP
AP
Location ..up-4 Suite � MEC
Contact Person - i1ti Ph ( ) 9 -2 /4 PLM SLR 0
Contractor Ph ( e ) SWR
BUILDING Tenant/Owner ' ;� % X4r_ ELC
Footing
Foundation Access: ELC
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_ PFIT FAIL
t rErEream UMBII
c
Under Slab
O
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower •
Othe_ ..ill
Fin - I -- '•wf
AS PART FAIL
MECHANICAL
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: El Unable to inspect — no access
Fire Supply Line
ADA �.p
Approach/Sidewalk Date _ 2-2 - " Inspector a► N oe �� Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL