Permit C ITY OF TIGARD PLUMBING PERMIT
'i" DEVELOPMENT SERVICES PERMIT #: PLM2003 -00237
`!'` �' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/3/03
SITE ADDRESS: 12485 SW WINTERVIEW DR PARCEL: 2S1106C -TS002
SUBDIVISION: "THORNWOOD ZONING: R -7
BLOCK: LOT: 002 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: Installation of residential backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 6/3/03 $36.25
LAKE OSWEGO, OR 97034 [TAX] 8% State Tax 6/3/03 $2.90
Total $39.15
Phone :
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 - 692 - 5945 RP /Backflow Preventer
Final Inspection
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
Is ued By: I ' ' , Permittee Signature: 0
Call (503) 6 -4175 by 7:00 P.M. for an inspection needed the next business day
Jun 02 OO 02:26p den edmonds 503- 692 -0768 P.2
i t,
Plumbing Permit Application FOR OFFICE USE ONLY
Received / es Plumbing / "� 7
Date/By: (J O' ✓ Permit No.: t../y/yr�� °FDA 2 J
City of Tigard . Planning Approval Sewer
f" Date/By: Permit No.:
13125 SW Hall Blvd, 1 _ V E D Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -417] Fax: 503 -598 -1960 Post•Review Land Use
4rs'o;.l; ?,;; i � 2 00 3 Contact
Date/By: Case No.:
Internet: www.ci.tigard.or.us luri
ection Re uest: 503 -639 -4175 "�`� c• � ® See Page 2 for
24 -hour Ins
l? q • • GARD Name/Method: / _ .Supplemental Information.
BUILDING DIVISION
�+ - ` ' ' ' TYPE•OF WORK ' " ' , • ' FEE +,SCHEDULE (for special information use checklist)
[,New construction ❑ Demolition Description I Qty. I Fce(ca.) I Total
❑ Addition/alteration/replacement ❑ Other: • New 1-4 2- family dwellings , • ,
CATEGORY OF CONSTRUCTION ` • • . ' ` • - (incl -100 R. for each utility con_ nection). •
iSk1 & 2-Family dwelling SFR (1) bath 249.20
y g ❑ Commercial/Industrial SFR (2) bath 350.00
DAccessory Building ❑ Multi- Family SFR (3) ath
) 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
: JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: / u/g - .Su3 (x:n e, ea) Dri ves • . , , •• . Site Utilities:. , - - ' • • , . .
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name r6 (spat Lew 0 DrywelUlcach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 71-16-y, -) wOoc(,, I Lot #: Gam. Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
D. SCRIPTION OF WORK Fixture or Item
La.PdS�a - t_ Absorption valve 16.60
yC` cY\.. h 1 Back low preventer I Page 2 27, SS
, C -4.: Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
0 PROPERTY 'OWNER ' I ID TENANT Drinking fountain 16.60
Ejectors/sump 16.60
fi �y se >7e
Name: r) ,rif- /7 47nes Expansion tank 16.60
Address: 4' Lai= S-W geeCyct 0Oej Fixture/sewer cap 16.60
City /State /Zip:L' e.c . eye 0k y 7 y Floor drain/floor sink/hub 16.60
Garbage disposal _ 16.60
Phone: Fax:
APPLICANT
[] Hose bib 16.60
0 PERSON • Ice maker 16.60
Name: FL £ r1 Spli_red u,) Interceptor /grease trap 16.60
Address: /..-. D St') hl Li S/u)-1 L RD Medical gas - value: $ Page 2
City /State /Zip :Tu.a_tes' h " 01��970lea.
Roof 16.60
Roof drain (commercial) 16.60
Phone 5 3 (9- - 69 y S I Fax:Sc.3 614 -6'76 8' Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
' CONTRACTOR . ' . .. - Urinal 16.60
Business Name: 1. -a-nctS c e� n rt - rm �iio Water closet 16.60
.1,1C•U y Water heater 16.60
Address:
/ Su 3 r» y s / oyl f 2h Other:
City/State/Zip: 77 -LA-10-7 - m._ Co(__ 9`70(4 Z ,_ Other:
Phone:503 (€ 2 -s`/ y5 Faxgl=3 (09a- 094,, • • . .. Plumbing Permit Fees* '
Subtotal $ •'7. SS
CCB Lie. #: 7SO 1., Plumb. LiC. #: Minimum Permit Fee $72.50 $
Authorized ,, , n J / / Residential Backflow Minimum Fet`.2 , � S
3 (; -
Si g nature: - 12 ! a-AA- tO Date: `� Plan Review (25% of Permit Fee) S
Elder) 4a i 1"07.i State Surcharge (8% of Permit Fee) $ ti. `/CS
(Please pnnt name) TOTAL PERMIT FEE $ 3' /. 1 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.
i:\Dsts\Perrnit Forms\PlmPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Reque ted (' _6 AM PM BUP
Location • _ / __A S e MEC
Contact Person Ph ( ) PLM 3- A -, 3 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain I M ELR
Crawl Drain L !", � h
Slab Inspecti 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: j 2 r
Final
PASS PART FAIL
PLUMBING
Post & Beam
UnderSlab
Rough -In N
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot
S PART FAIL
CHANICAL
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 i Inspector" Ext
Other:
Final D • OT REMOVE this inspection ecord from the job site.
PASS PART FAIL