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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00619 �� 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 11/2/2005 PARCEL: 2S109DA -11400 SITE ADDRESS: 12994 SW BLACK WALNUT ST ZONING: R -7 SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 103 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 11/2/2005 $36.25 [TAX] 8% State Surchar1 11/2/2005 $2.90 Phone : 503 - 387 - 7538 Total $39.15 Contractor: LANDSCAPE OREGON, INC. 12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS TUALATIN, OR 97062 Phone : 503 692 - 5945 Reg #: LIC 7804 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. Issued By:, Permittee Signature: o C CAW f it Ph Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. b$aalllelIllla IFll (lnnrte5 ��8 . fartlnb .;Peinfrrintt A i� aill ur.NOV 1 2105 - . City of Tigard I Received ( 612 13125 SW Hall Blvd., Tigard, OR 97223 Date/B P i (� n D y CITY OF T aAR • r: r'1/ /"l Phone: 503.639.4171 Fax: 543.598.1960 t r i IL 1 Plan Revie BUILDIN ar'. 1'iJ Date/By: Other Permit No. Phone: Hour inspection Line: Fax: 50 P Internet: www.ci.tigar 5 s -r =t - Date Ready/By: J�u ®Se Page 2 MotNotified/Method: 1 / � y Suppl emental Information TYPE OF WORK // CAD - FEE* SCt.I ULE fl New construction ❑ Demolition For special information use checIJisr. Description Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: _ New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath l 0 I 249.20 I 1 -and 2- family dwelling - f Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Other: Each additional bath/kitchen 45.00 JOB. SITE INFORMATION AND LOCATION • Fire sprinkler ( sq. ft.) Page 2 Site utilities Job site address: /,? 4- 5 ' Cyf •Stu 5/a_ C to ZT �d t. Ste' Catch basin or area drain 16.60 City/State/ZIP: -_ l C CuCC / 4/ 7 7 - I f j U a D r y well , leach line, or trench dram 16.60 Suite/bldg. /apt. no.: Project nar j j,u. m 4 . � ye /6)3 Footing drain (no. linear ft.: ) i Page 2 Cross street/directions to job site: Manufactured home utilities 1 10.00 • ELL) Q Ge- ! R-D Manholes 16.60 • �< Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: S Mme. j 4YC'.� I Lot no.: ( L) 3 Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: (U 7 S S A. Fixture or item DESCRIPT ON OF WORK Absorption valve I 16.60 Baekflow preventer / Page 2 ,a V - / / ( C f i ;• / Backwater valve 16.60 V - Clothes washer 16.60 • Dishwasher 16.60 • [1 PROPI RT. ol*NiR E Drinking fountain I' : • ❑ TENANT 16.60 Name:, - Ejectors /sump - D -1 , ,� / s s `. 7i r - 16.60 �y) e_s Expansion tank 16.60 Address: L-7 3 c, ..c u 9 6 ` to 0 OC Fixture /sewer cap City/State/ZIP:Lt:,1.. C. 0 j S ' 16.60 c-l1 �C? U � • � L, � =; Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 ;APPLICANT . • • `© CONTACT PERSON ' Hose bib 16.60 business name: ( fin/ f 11 � -� r �� -- - Ice maker 16.60 _ 9/%'1 r„ Contact name: f Interceptor /grease trap 16 60 ! Medical gas (value: I ) Page 2 Auuiess: r ' •&-L)L) .v tt LJ r. illi-i„ciarkij RD Primer 16.60 II City/State/ P: 1 , G14 L , -d c y • Roof drain commercial 7G(� (commercial) 16.60 9.-Q - Phone: (Sir.:)) (G' -..S c -- .; : ( - u Sink/basin/lavatory I Fax:: (�� .j) _� - ry 16.60 E -mail: Tub /shower /shower pan 16.60 -- -- - Urinal 16.60 . • CONTRACTOR -- Water closet 16.60 Business name :/ r f)i_s 0i' / -1 r l' cf� /; `. Water heater 16.60 Address: /',l -4-00 .S W s r;. u.S,i/ 0 2,:� Other: /State/Z1P: r J ry /% � 4J 7! � .:;•'-- .:;•'-- Subtotal Ci Phone: (() /f' I e Minimum ermit fee. $72.50 + `� J Fax: k 3 C , °� „ 07 E. Residential backftow minimum permit fee: 536.25 �4' , i s CCS Lie.: 7 c'O L/ I Plumbing Lic. no.: Plan review (25% of permit fee) Authorized signatyF" ` • n State surcharge (8% of permit fee) 0 ,, o v vrr . /J ,, sr ,./.,...-, � o. `o f p Print name i54/ : >t TOTAL PERMIT FEE I3 , f S x r:� i t ; G!;'� J {.` I DaiiD j 3110 1 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. "Fee methodology set by Tri -County Building Industry Service Board C' auilding PcnnitApp.dos :2/03 4 .1616f(, I 0/02/CON.Uw031 S'd 89L0- Z69 -EDS uaT T 3 eb2:80 SD TO AoN • CITY OF TIGD BUILDING DIVISION PERMIT #: PLM2005- -00619 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/2/2006 Phone: (503) 639-4171 a hl " _ Inspection Requests (24 Hrs.): (503) 639 -4175 �..' � 'L 1 1 INSPECTION WORKSHEET FOR DATE: 11/9/2006 TIME: 7:09AM PAGE: 67 1 SITE ADDRESS: 12994 SW BLACK WALNUT ST CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 103 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE NO. 2 DESCRIPTION: Backflow preventer for irrigation. OWNER: DON MORISSLI IE COMMUNITIES, LLC, PHONE #: 503- 387 -7538 CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692- 5945 Inspection Request Scheduled For: Date: 11/9/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 020697 -02 503 - 692 -5945 N Corrections /Comments /In tructions: .'—" Te— 4 \ , . • i PASS ri PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 1U� Date: 1 t / Phone #: (503) 718 - t