Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00673
DATE ISSUED: 12/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 109 D B -04000
SITE ADDRESS: SW NO ADDRESS TRACT "H" ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: OOH JURISDICTION: TIG
Project Description: Backflow preventer for irrigation. Summit Ridge Park.
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 GALEWOOD ST #100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 12/6/2005 $36.25
[TAX] 8% State Surcha 12/6/2005 $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.
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Issued By : Permittee Signature:
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
`DECEIVE
Numbing Permit A Iicalhox
LtiV J L 5 2�� FO OFFICE USE ONLY
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City of Tigard Received . �" �
13125 SW Hall Blvd., Tigard, OR 9722�?t CITY Oh I IGARp DatcBY:/ '1( � '�1� remit No ` t�� - 006 ?/j
Phone: 503.639.4171 Fax: 503.598.196(UILDING DIVISIr - F Date/t3 v iew p J
� Other Permit No.:
24- Hour Inspection Line: 503.639.4175
Internet: www.ci.tigard.or.us .?� �� E L Date Ready /6y: Juris See Page 2 fur
Notified/Method: 1 t� Supplemental Information
TYPE OF WORK FEE* SCHEDULE 1ew construction ❑D emolition F special information use checklist.
J Description I Qty. f Ea. 1 Total
❑ Addition/alteration/replacement ❑Other. New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath I 249.20 '
.\ 1 -and 2-family dwelling ❑ Commercialindustrial SFR (2) bath 350.00
❑ \ A ccessory building ❑ Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00 1
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORtMATION AND LOCATION
Site utilities
Job site address: TI .n - A GT W Catch basin or area drain 16.60
City /State /ZIP: 7/q -2CL 62),e_. 9 7 ?�� Drywell, leach line, or trench drain 1 6.60
Suite/bldg. /apt. no.: !! Project names if l/g p Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: "'7 J Manufactured home utilities E 10.00
�y�(� Manholes 16.60
LJ
s-C. 13 'v- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Si- 1•n'UVl L .,. �d y Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: as 10 0 i3 - 0 110 O 0 Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
^ Bacicflow preventer / Page 2 oZ 7 „s
/ .. {.0 ,,, r /7I ./-1`i (i ✓ ;�'�C!.e';(?"l i'P. "•.: r_,,
.! 6 _) il Backwater valve I 16.60
Clothes washer 16.60
Dishwasher 16.60 •
Q PROPERTY, OWNER ❑ TENANT Drinking fountain 16.60
Name: C l� . t Ejectors /sump 16.60
r eit- -1 S. I Ii C S Expansion tank 16.60
Address: L- f 3 L, S Ut 6::-.z, / L ; _, `I C _ t Crct Fixture/sewer cap 16.60
City /State/ZIP:[ .k C.. C) L ; c'
c , Ulm. l
l � 'y '7 4 . � S Floor drain/floor sink/hub 16.60
Phone: (533 ) 3 Q 75" 3 , Fax: ( ) Garbage disposal 16.60
• �AP . 'ELCONTACT PERSON Hose bib 16.60
_ Ice maker I 16.60
I Business name: / •:./ . Ci .s (".f .".1 . r.... - /) (vn � , I
� Interceptor/grease tra
( I P 16.60
Contact name: ,."-.,• / U r) 'N (;',r �V Medical gas (value: $ ) Page 2 •
Address: ' J 2, Ci t.:
e � CO n j t., ( : /'i;`: ` .° ;2•0 Primer 16.60
r
City/State/ZIP:--p, 'Lill &. CA.- • 7 7L' Roof drain (commercial) 16.60
Phone: (,S6t (L 9.:-.? - �jt:J� Fax: : v.� - C `y f: Sink /basinilavatary 16.60
E -mail: Tub /shower /shower pan _ 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: / f� �4,_S i.�� 0;2-7 9 W ater heater
�' fGi. �'> �C t6.60
Address: / 1- -- ( 1 & S ie) ( =-1f;.. ji;l. t.14 �p Other:
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City/State/ZIP: ` �; - 1 iet " � ::::,_. Subtotal
Phone: �• C"C - Minimum permit fee: $72.50
(`:y 3) j� „� s Fax: / ) �� 070E Residential backflow minimum permit fee: $36.25 . 3Ies- o-S'
CCB Lie.: ,r L.) L Plumbing Plan review (25% of permit fee)
. ` ( r Plumbin Lic. no.: I State st i
Authorized si a rf 1l / rrhar (8% of permit feel I c y Q
v v i 'G 4�1jLfYi� , I TOTAL PERMIT FEE 1 37. ( S
Print name_ . /1 & GCi' � -
•- f •7 i - `_) � Da t` � (� �/ This permit application expires if a permit is not obtained ,. :thin
/ ( 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
ianailding \Permits\PI-MF- Pn 12/03 440- 4616T(10 /02 /COM/)JEH)
T'd 89L0- Z69 -E09 u aII e8S:80 50 90 Oen
CITY OF TIGARD
BUILDING DIVISION
Al PERMIT #: KM2005-00673
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; 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/U2006
Phone: (503) 639-4171 , .-Aoldi
Inspection Requests (24 Hrs.): (503) 639-4175 .....M 111.
INSPECTION WORKSHEET FOR DATE: 5/1/2006 TIME: 7:00AM PAGE: 57
SITE ADDRESS: SW NO ADDRESS TRACT "H" CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 0011 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE PARK
DESCRIPTION: Bacidlow preventer for irrigation. Summit Ridge Park
OWNER: DON MORISSETTE COMMUNITIES, 1.1L, PHONE #: 503-387-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945 .
Inspection Request Scheduled For: Date: 511/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 028985-01 503-692-5S5 V
Corrections/Comments/Instructions:
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Air - Agit Aft Illlir .." .... _.4 ,
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iti-pAss 0 PARTIAL APPROVAL fl CANCEL El NO ACCESS
r7 FAIL fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: 11 1 (4. Date:
Phone #: (503) 718-