Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00691
DATE ISSUED: 12/15/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -10600
SITE ADDRESS: 12926 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 095 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 #100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 12/15/200`. $36.25
[TAX] 8% State Surcha 12/15/200: $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: _yam
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.
a • ;
` 'Building Fixtures
luIr1Hhing Permit A+ II I r�f i4a� l�a� ., ., . •
_ • F OR ' OFFICE ;USE ONL
City of Tigard Received
Permit Na.
13125 SW Hall Blvd., Tigard, OR 97223 [�` '� ('� 205 D ate/D y %L 5 ....- 7.25 -- -- --;*
� � 1` � \\ n l
Phone: 503.639.4171 Fax: 503.598.1960 1DL�+ Plan Review
- , A�Yp ''1'jli�o DateBy: Other Permit vo.
24- Hour Inspection Line: 503.639.4175 ! -J i�, e:iiiiI
Internet: www.ci.tigard -or.us T`, O�• ® s �r' Date Ready /By: Je� jr fl Sec m Pane l Car
�I b ] ri C` l 1 IT • No lifiednvlethod. i jfi V Suppleental tarunt. lion
rs 3 < • TYPE o' • r FEE* SCHEDULE
information ,New construction `` r ormation use checklist.
❑ Demolition P
Description 1 Qty. 1 Es. ! Total
❑ Addition/alteration/replacement _ ❑ Other: New 1 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUC'T'ION SFR (I) bath 249.20
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 ❑ Other: -
Fire sprinkler ( sq. ft.) Page 2 '
•
- JOB SITE 1NFORM.ATION AND LOCATION Site utilities
Job site address: / !?�&•, .&Lt) /)[&-G L. t LLJ1.L1. f ...S.4-, Catch basin or area drain 1 16.60 I i
City/State/ZIP: •7 l a_t_t _ op_ 9 --7 , . oZci Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project t tt mi . 1 4 . .j- le , e' C Footing drain (no. linear ft.: ) Page 2 i
J Manufactured home utilities 110.00 i
Cross street/directions to job site: J
y � ,!� Manholes 1 16.60
St)-) F ' c_f • enci T -0 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision. Water service (no. linear ft.: ) Page 2
�-E'rr1 /V1.LT kte y- Lo no j l
� Fixture or item
Tax map /parcel no.: S ` �
\ RRR��� /PPP Absorption valve 16.60
DESC TION O.F WORD
Backflow preventer / 1 Page 2 �7 .S S
mss.'.•;'312 (..] /` " It 6 /O- •( ;TA ,�0_, /s' l.n ` i C ;f�_ )i/ Backwater valve 16.60
Clothes washer 1
. 16.60
Dishwasher 16.60
PROPERTY. OWNER Drinking fountain 16.60
_ ❑ T ENANT.
i/� i ,. �,� Ejectors /sump 16.60
Name:
Cif i /(i i�r/ S•S f.', / C J
Expansion tank 16.60 1
Address: y& J L' ..S LiL.. 6 c _ c_.c-t i
( � C % f ���� Fixture sewer cap 16.60
City/State/ZIP:L/7 /< (T..Si'..; C <rc c-k. ' % L.i y S Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
lq , CONTACT PERSON • Hose bib 16.60
I - 16.60
Business name: t, /.; (f > l.C% ly"i >/�/ r1 L% �i
Ice maker
r Interceptor /grease trap 16.60
Contact name: ,J a r ,f'\ , -2l -' : /
1 r •. ,,.y -r • r Medical gas (value: $ ) Page 2
Address: ; '''x-1))( f w e 9` / �'
N i C. ; ivy, S ' ?'�., Primer 16.60
City/State/ZIP:1 ;U /L, is 7,.; 0 � '7 , Lo Roof drain (commercial) 16.60
Phone: /') ( t/, - J �� yi c° , _ . Sink/basin/lavatory 16.60
(Si ,� J I Fax: (.-:5 .�) 6..' Y h; - �' �'
E -mail:
• Tub/shower/shower pan 16.60
.__. __ Urinal 16.60
CONTRACTOR Water closet I 6.60
Business name: (-/)f S( t.i..:. 6,-172-.9,/,7--1 �� y Water heater 16.60
Address: / Zo-6 S /0 F/) ' ; c y ^ L ' �r� Other:
City/ State/ZIP: 'I/ ete,e -� n jO Z. f Gi,(0 ; -4,_. Subtotal
z Minimum permit fee: 572.50
Phone:
(5."`✓3) & ,-� "� Fax: ( �) l09Q . 070 E Residential backflow minimum permit fee: $36.25 3 (' • ,..S
CCB Lic.: 7 - t..i' t t Plan review (25% of permit fee
J Plumbing Lic. no.: ( P fee)
Authorized signs I f! V im ; • State cpr (8% ofperrnmr fee) I , 9"C)
``� ` � :mo d' TOTAL PERMIT FEE 3
Print name: ,o ..y '- I Pe 44 - U This permit application expires if a permit is not obtained s, 'thin
18D days after it has been a ccepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i :\BuildmgtP. rroics\PLMt Perr,dtApp doe 1:1/03 440- 46 10 /02 /COM/WEI3)
a - d 89L0- Z69 -EDS u e6Z =60 SO -17i oaU
CITY OF TIGARD
BUILDING DIVISION ' PERMIT #: PLIVI2005-00691
13125 SW Hall Blvd., Tigard, OR 97223 ,, - „...
iallit DATE ISSUED: 12/1612006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 it
INSPECTION WORKSHEET FOR DATE: 12/16/2005 TIME: 1:06AM PAGE: 74
SITE ADDRESS: 12926 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 095 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSE! I E COMMUNITIES, Ile, PHONE #: 503-387
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503
Inspection Requ'est Scheduled For: Date: 12/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 023606-01 50:3-692-5945 N
Corrections /Comments/ Instructions:
•
/ -
_ ------ '
6 SS PARTIAL APPROVAL n CANCEL E NO ACCESS
I FAIL 0 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
. ) „
Inspector: Date: " ' • Phone #: (503) 718-
/ " w
. , .