Permit CITY TIGARD PLUMBING PERMIT
jej ''i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00287
��) I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/28/2005
PARCEL: 2S109DA -13000
SITE ADDRESS: 12996 SW BIRCH HILL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 119 JURISDICTION: URB
Project Description: Irrigation backflow preventer.
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 HOMES INC Description Date Amount
4230 SW GALEWOOD ST 100
LAKE OSWEGO, OR 97034 [UPLUMB] Permit Fee 6/28/2005 $36.25
[UTAX] 8% State Surchf 6/28/2005 $2.90
Phone : Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
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 , .%•9 •r 1 -800 -3, ,, -2344. y�
Issued By: �i i ,,16e) Permittee Signature: o I)/
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
Plumbin Permit A far ottOV ��
City of Tigard In' 2 FOR OFFICE USE ONLY
13125 SW Hai] Blvd., Tigard, OR 97223 JUN OV 2005 Rece •/ I
Phone: 503.639.4171 Fax: Date/By: y `• 02 Pcmzit No M
ax: 5 w Date/By:
Review J �1�
24- Hour Inspection Line: 503.639A 17 '�� _ ` ,, ,, h S' �'+ Date/By: Ocher Permit No.:
Internet: www_ci.tigar 5 s OF TIGARD 1 L Date Read B
• FSINir± Ready /73y:
_ n , O : Notified/method: [�� !� or
rmation
TYPE OF WORK Supplement See Page 2 I
New construction FE 5 SCHEDULE
❑ Demolition For s.ecial information use checklist.
Mall
❑ Addition/alteration/replacement ❑ Other: Descri•tion
Ea. Total
New 1- 2- family. dwellings (includes 100 ft. for each utility connection)
Ike CATEGORY OF CONSTRUCTION
1 - and 2- family dwelling SFR (1) bath 11111 249 20
❑ Commercial/industrial SFR (2) bath
❑ Accessory building 350.00
❑ Multi - family SFR (3) bath
399.00
❑ Master builder Each additional bath/kitchen
❑ Other: 45.00
JOII. SITE 'IIYF ORiVIATIOIV AND 'LOCAT[OlY Fire sprinkler ( . sq. ft.) Page 2
lob site address: /Q 1 ry., /3 J
e__, Catch basin or area drain _
City/State/ZIP: -T/ a. p� p 16.60
/ 7 r _ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt_ no.: project name.
U /y) 'IA_ q` /0_,„1__.‘ /l ,� i Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities
.�♦✓U 110.00
r a n Ma 16.60
/� l/ Rain drain connector ME 16.60
Sanitary sewer (no. linear ft.: ) _ani
Storm sewer (no. linear ft.: ) Page 2
Subdivision u m _ 0 ./
/� Lot no.://q
Water service (no. linear ft.: ) 11111 Page 2
Tax map /parcel no.: Le) �S4 Fixture or item
DESCRIPTION OF WORK Absorption valve 16.60
�' �!` j r- r ; ( /r'r ( �� i !�/ 0 v - Backwater preventer Ira Page 2 7 . SS
�� / / / ( / valve 16.60
Clothes washer 16.60 •
•
Dishwasher 16.60 •
' PROPERTY OWNER Drinking fountain _ 16.60
0 .TENANT
Name: n-),t nc , Ejectors /sump 16.60
D ()), . � s � � .
Address: 1.-71.,,.:,)_ 3 L t & / r J Expansion tank
S �3 C'.��10 Csc'L :
16.60 -
City/State/ZIP:�� G, Fixture /sewer cap 16.60
C 5. -C` U O / 71=3 S Floor drain/floor sink/hub
16.60
Phone: ( )
Fax: ( ) Garbage disposal _
16.60
`13.1..APPLICAYT CONTACT PER Hose bib _
16.60
Business name: L C[ „c (•-/.L •••'_, Of -ct Ice maker
'! G 16.60
Contact name: E � Interceptor /grease trap 16.60
Address: ` 2 - C) i , ,. Medical gas (value: $ )
��`•�' �' L 1 Li' I`2•� Primer • r
City/State/ZIP: U a4 U2 16.60
Phone: t a 7L �- R oo f d ra i n (commercial)
(5� 3 ) ",`� - S��J Sink/basinllavatory 16.60
16.60
mall, Tub /shower /shower pan 16.60
• CONTRACTOR Urinal 16.60
Water closet 16.60
3usiness name:
L• ci_Sr i • '� - Water heater
\ddress l n �
I �d.-0G .1 U S - / LYI.•t -i ;rn Other:
:ity/State/ZIP: .-.) /�
j_/y [J� 'U�O '� Subtotal
hone: (�j(� IoY� �3 Residential backflow minimum permit fee: 536.25 3C Minimum permit fee: $72.50
�) S Fax: (50 6 , D7
:CB Lic.: 7 Et 3(g:, -`
_ Plumbing Lic. no.: Plan review (25% of permit fee)
.uthnrized sien241 L"i /� l State surcharge "2S% of permit fee) ' }
rint name TOTAL MINI TOTAL PERMIT FEE 39 (S
`f) .5, Da •� This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
tui [ding\PcmeuIPLMF•Pennitgpp,doc 12/03 *Fee methodology set by Tri-County Building Industry Service Board.
440.4616T(1 0 /02/COM /WEg)
ua1 0120:T SO 8Z uric
2'd 89L0- Z69 -EDS
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00287
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/28/2005
Phone: (503) 639- 417 1 dr �pu� °U�t?I�I'I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7:06AM PAGE: 66
SITE ADDRESS: 12996 SW BIRCH HILL LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 119 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Irrigation backflow preventer.
OWNER: DON MORISSI~ fTE HOMES INC, PHONE #:
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503..692 -5945
Inspection Request Scheduled For: Date: 8/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 013403 -01 603-692-5945 N
Corrections /Comments /Instructions:
•
(://
•
-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
4 11 Inspector: / Date: Jr, Phone #: (503) 718-
r,