Permit P
CITY TIGARD PLUMBING PERMIT
,;, D EVELOPMENT SERVICES PERMIT #: PLM2006 -10010
-,,,, ' .��I DATE ISSUED: 3/2/2006
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109D B -03100
SITE ADDRESS: 15046 SW 132ND TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 069 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
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
Owner: FEES
DON MORISSETTE COMMUNITIES LLC
4230 SW 132ND STE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 3/31/2006 $36.25
[TAX] 8% State Surcha 3/31/2006 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -5945
FAX 503- 692 -0768
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 or 1- 800 - 332 -2344.
Issued By: ' Permittee Signature: -P ( D
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Fixtures •' E C E IV E"
Plumbing Permit Application, � 03/
FOR OFFICE FILE USE ON
R City, of Tigard h E Ll 0--)- - - 00 r, Received
1.3125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGP D Dat � 'Q 6 PemritN ��� ) i6t { -� aD`
Phone: 503.639.4171 Fax: 503.598.1960 / /F , o , I t Plan Review
Fax . i/tJW
Phone: 503.639.4171 Line: : 503.639.4175 BUILDING D I \ . ' " twiny' il l Date/By: Other permit No.:
Internet: w "� r. Date Readyf8y; fur
Notified/Method: l3 See Page l for
? „�y� '�' -zvr� i,,,� ^4,t•Sx �.)5.4 "Tr "3�'+ � Supplemental
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a New construction ❑ Demolition _For special information use checklist
❑ Addition /alteration replacement Description
❑ O ther Qty. Total
+ n err fYs yu New 1 -2- family dwellings (includes 100 ft. for each utility connection)
L tae a. , uy l ��r a ' ,�iinFK: ' ".. SFR (1) bath 249.20
all I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath kitchen 45.00
❑ Master builder 0 Other:
�G�4 ∎'. . 1 �� ' 44.F, Fires nkler
.�i'.'.a. v ,_: V .a '�- 11�'�.31 t�' I�S;1 �, oYalt � \a llt lLi�kl� lt} yam!'a 1:-•'''''."-";'•.' I * Im ( sq. ft.) Page 2
u _� ii, ) iVilu ;j Y qi ..:a,ff r.b4�r;Il'. Site utilities
Job site address: S0'- -i (�, ij, 1 1 3 2 y)
-� 1�-teC Catch basin or area drain 16.60
City/State/ZIP: 7 C cLt 0 /Q.._ q 7 - ; Drywell, leach line, or trench drain 16,60
Suite/bldg. /apt_ no • 1 Project name: saM YYI o f-- fa E 62 9' Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
C CO Manholes 16.60
e -F / na.___ Rain drain connector
16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision : Lyn CY) Li - RA...a q -c-, I Lot no.: &) 9, Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: CO S a Fixture or item
m �
b ' ; • 4 t ' �" rr r e a st d 5 0 ; " , r,,,r , ;t Absorption valve
s . ' s } l f [` .;,:.+ . „-� , .. -, ,, , ;' =:5 t .. 1 ,� 16.60
�"'_ �' ` . ^ a ": . Backflowpreventer Page 2
L�, ape, /ir/ Ce: 3 htJ F-/ °L(.) Backwater valve ' 6 2'7 SS
�� % /!,f' 16.60
Clothes washer 16.60
Dishwasher 16.60
l -n. s „n r .�- �vt , v f> 74 k: t }9 1 X yak fr og regiC iy � � 1 i
Drinking fountain 16.60
Name: Ejectors /sump 16.60
DLTrt VY)L�-/ ss e_ f 4 ms's C Th nu.n.ches / I . r
Expansion tank 16.60
Address: LIa 3 o S r J _1 6�L.(e.-e.1) 0 OC
t, Fixture/sewer cap 1 6.60
City/State/ZIP: La k e. p E
9 U Ok- 7 03 S Fl oor d rain / floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
1 f "7 T1 K 1�i i i< r b y *° . Z t J R R V fr'iii �(t�� . �' ,� k
nl...; , lea _.: t a' i r :,�h '18t, , ..::Fla:: f l .11A * 7 Ct11 )Q Pd O •' PA, . Hose bib 16.60
.�.... . Ice maker
. Business name : d S Ca_G cYe • C)", ... / ' 16.60
Contact name: e f ^ err V Interceptor /grease trap 16.60
{� �J ICJ Medical gas (value: $ ) Page 2
Address: / -3O0 S-U_) MI/S Lj f2,() Primer 16.60
City/State/ZIP: J 7 7 . (0 ( ) 16.60
�Q-�. (.(.�']� G (L. � Ro of drain cornmercial
i Phone: (,503) (o j,_ -.S%y5 l Fax:: (5 6 y _ C 76,5' Sink /basin lavatory 16.60
1 E -mail: Tub /shower /shower pan 16.60
trr rr t 1 R r xr' � iia [n ., 'a � 4 ,:, t , ,` ; Rl 1" l ..{ ,, .; ie •. ..:: 'r ;,, , ,4- .. Urinal 1 6.60
I �_:, _vim .l tu.:_L,,�u r_n, t ti a4 $ .2, .. t N �:`fr - , , "! ,;1 ;4" �:;, Water closet 16.6
/ �, ,, �/ �..
Business name:
-c i... fLiSe ar- 9(97"1 G Water heater 16.60
Address: , -?-GO S /; r m u.S-1 r5n•u P _ Other:
CAty/State%"P: f'` . v � �7U� Z - _ -- - Subtotal
Phone:J�) �7� V / /� Minimum permit fee: $72.50
7�s Fax: 6 �) 1�7 - U7( Residen tialbacicflowminimumpermitfee: $36.25 3(o Q - S
CCB Lie.: 7 eG Plumbing Lic. no.: Plan review (25 of permit fee)
Authorized signa X ,, State surcharge (8% of permit fee) c C , ,
_� TOTAL PERMIT FEE
`/ I
Print name .3q , ( S
1/ ,J I Da ' / 31 o (�, I This permit application expires if a permit is not obtained within
1111 1 180 days after it has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board.
iAlluitdingUPcmuts1PLMF_Pe n'.itAppdoc 12/03 440-4616T(10 /02/COM/VEB)
T' B9L0- ZG9 -EOS UaTT3 dizZ:ED 90 TO JeN
CITY OF TIGARD RECEIPT
R ECEIPT DATE:
DEVELOPMENT SERVICES 3 ; 2 °
° "po 13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.: ly Cr,
.y j f
: .. 503- 639 -4171 www.tigard - or.gov CASHIER DATE:
CASHIER RECEIPT #:
LINE ITEMS:
Case No. Fee Description Revenue Acct. No. Amount Due
5•
\� 1� 47 'x!
_._...._ _._ �1'�.._ _.._.. - -. - ._...._...._.__..._ - -- .._.... .....,........._....._......_.. __.._.... __...._._.....__._ .._.._...._.._._ tom"',,.- - -- -.
I i
Total Due: $ ` , 6
❑ SEE ATTACHED FEE SCHEDULE.
PAYMENTS:
Payer:
Method f Initials ; Check No. Confirm No. 1 Amount Paid
(. : 57 3c9, /5
Total Paid: $
I:\ Building\ Forms\ ManualPermitForms \ManualReceipt.doc 03/01/063/1/2006
CITY OF TIGARD p L
BUILDING DIVISION PERMIT #: 006 �10 61 0
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 * 4
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: (5 C f ( / 3 '1 6 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3^ /5" — a ( e Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 c/ 5, V
J dtCT"iow
Corrections /Comments/ Instructions:
Xl PASS [ I PARTIAL APPROVAL ❑ CANCEL NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
%6
Inspector: 4 8 1i-' 1 f _ Date: L3 ! / '(o Phone #: (503) 718-