Permit •
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005-00647
� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/23/2005
PARCEL: 2S109DA -12700
SITE ADDRESS: 12920 SW BIRCH HILL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 116 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 Description Date Amount
4230 GALEWOOD ST. STE 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 11/23/200` $36.25
[TAX] 8% State Surcha 11/23/200E $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone : 503- 692 -5945
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: ' ;? Zis..c.l Permittee Signature: k,, \N
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.
3illllklhl g iF xtL.u
il'!ll2IIl Dt1ilIl t�IC1I➢Illl1L Application is r•' `
, aFUR� OI1 CE USE` O1r . > +.
City off T
����
Plan Review
I s,:nic ar;. � /t ttYfaf.',f;.t:1at�.� t'..�.rc +„ � Y
Tigard C E 1- Recet y B /r7� -,� V,7 „�I ! Per
EN E"-
• pateB j !7 mit No ‘Vi
13125 SW Hall Blvd., Tigard, OR 972E �/
Phone: 503.639.4171 Fax: 501598.1960 '^ II �ll) Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 fl \i 2 9 20 05 4.44,;;;.:41,..-,!..is D ate Ready/
By: www.ci.tigard onus a .��.. �O O See Page 2 for
C Notified/Method: (� I Supplemental Information
TYJ�I ,51r w �� --
- )NIS I O �
[ FEE* SCHEDULE
i ; New construction gu1LD Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration / replacement ❑ Other: New I - 2 - family dwellings (includes 100 ft. for each utility connection
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
El Master builder ❑ Other:
• 1 - Fire sprinkler ( sq. ft.) Page 2
JOB. SITE INFORMATION .AND' LOCATION Site utilities
Job site address: l 9.L L) V; ! / I I / . _ - -
e), ���� lT/ 11E Catch basin or area drain 16.60
City/State/ZIP: 7'1 �� 4 «C.. 9 '7 R. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project, ),n i. L ( ? /! j F _ Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
� - Manufactured home utilities 1 10.00
r Manholes 16.60
F •`r" ` C Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2 •
Subdivision j L pr) - lac £.L 5/ Lot no)/ Water service (no. linear ft.: ) Page 2
/ „ � ( Fixture or item
L
Tax map /parcel no.: , /
Absorption valve 16.60
• :DESCRIPTION OF WORK Backflow preventer / Page 2 0 7 , s - S
i 6...,7 - )G -S( u pc� i rr, l.,/ / / -rti' fly) 7,o_.cjr / G7 !.l z:f ; fR . Backwater valve 16.60
r
Clothes washer 16.60
Dishwasher 16.60
PROPER7GY. Q, WNER. Drinking fountain 16.60 • R . 0_ .TENANT
' • Ejectors /sump 16.60
Name: b cyi r i)(31, s s t ./ r /. , e.S Expansion tank 16.60
Address: .4-7 3c U! & e_k_.0 0 clC
L Fixture /sewer cap 16.60
City /State/ZIP: a_ k ;. S c..0 Z ?() O/&. ‘ . % 0'3 3 Floor drain/Boor sink/hub 16.60
Phone: ( ) / Fax: ( ) Garbage disposal 16.60
• APPLICANT'CONTACT PERSON Hose bib 16.60
Business name: �1' -1� /l S CcL n .,� (:)(-- _ii , ..T.,,--) - Ice maker 16.60
Contact name: / `1 In
trap 16.60
t ` / t 04- Medical gas (value: $ ) Page 2
_ g
Address: i 0 .- :) r; a..,. c-. /VII I.' f 2:t� Primer 16.60
City /State /ZIP: -1 ; /L; dVl 423(__ , J 7 70(0;.A.__ Roof drain (commercial) 16.60
Phone: (56 ( G C / -S %' (/� Fax:: (_/•- & Y,7 _ ')&,,,,i, Sink/basin / lavatory 16.60
E -mail:
Tub /shower /shower pan 16.60
Urinal 16.60
.. CONTRACTOR Water closet 16.60
• Business name :/_ ,AG±� co,,-,, . O7 jU ?^ C. Water heater 16.60
I
!
Address: / ‘ )---00 ,S //,) / ), ,, , s4c Other:
4
City/State/ZIP: 7U,0,-J/4-1-10.. Si 0� ‘.471--.3e0 ' Subtotal
7 / Q6�/�•' j- Minimum permit fee: $72.50
Phone: lei3) "��5 ' � Fax: 603) ( 9 o /67 (0 E' Residential backflow minimum permit fee: $36.25 3 • .)._5
CCB Lie.: 7 lS'UL Plumbing Lie. no.: Plan review (25% of permit fee)
Authorized ^ "r^ , ° State surcharge (8% of permit fee) .7..D. . , C1 C
r ' - ,( 11 ,� (:L�L/L✓9/'?1 TOTAL PL-RMIT FEE
Print name: e,..••,1 �
�.,...�� ��� . C{ '� > L,a Dab I This permit application expires if a permit is not obtained i.-ithin
180 days after it has been accepted as complete.
*Fee methodology set by Tn - County Building Industry Service Board
islt luildinglPermhs1Pt.MF- PermitApp doc 12103 440-- 461.6T( I0 /02/COMAVF__B)
1' 89LO -ass -COS u a113 e6a :60 SO 81 AolJ
CITY OF TIQARO
BUILDING DIVISION PERMIT #: PLM200 -00647
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: . 11/2312005
Phone: (503) 639 -4171 /�i,4/ i lil
Inspection Requests (24 Hrs.): (503) 639 -4175 ' :_..
INSPECTION WORKSHEET FOR DATE: 12/612005 TIME: 7:02AM PAGE: 10
SITE ADDRESS: 12920 SW BIRCH HILL LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 116 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Saddle/ pre/enter for irrigation.
OWNER: DON MORISSETTE COMMUNITIES, LLC, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 603- 692 -6946
Inspection Request Scheduled For: Date: 121612005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 023015-02 503.682 -6076 N
Corrections /Comments /Instructions: I
V /
;} cL C
.
y
1
SS I I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
l
Inspector: Date: I /�/ - Phone #: (503) 718-