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Permit I r C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00649 DATE ISSUED: 11/23/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DB - 02600 SITE ADDRESS: 15045 SW BLACK WALNUT TERR ZONING: R - SUBDIVISION: SUMMIT RIDGE LOT: 064 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 4230 GALEWOOD ST. STE 100 Description Date Amount LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 11/23/200E $36.25 [TAX] 8% State Surcha 11/23/200: $2.90 • Phone : 503- 387 -7538 Total $39.15 Contractor: LANDSCAPE OREGON, INC. 12200 SW MYSLONY RD. TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS Phone : 503- 692 -5945 Reg #: LIC 7804 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. By: � J Pe rmittee Signature: �j Issued B \p c. Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. 3allfiklhang Fixtures �111Iliinbll114 frTnniit A llicattio]ln x < " !t`$'; " lEr , r I� _ \ p e , .. . OR OF,.F[ C1 SE ;©.*Y , "_ .• �: 13125 ®ff 1 l3j ll � EA 1 Date/By: / /�t7L✓ �G° / Pemut No � ISI `:/V O64 13125 SW Hall Blvd., Tigard, OR 97223 11 111��� Phone: 503.639.4171 Fax: 503.598.1960 t t t ��r, >;atW Plan Bey Other Permit Review t No.: 24- Hour Inspection Line: 503.639.4175 1, 6r � " ! (' ,t °t + t. tR, Ju vnv.ci.ti ard .or.us ° , mate y: Internet: w Notified/Method: S S°c Pane tot g .., 1 �� Supplemental 21 Inl'orma[ inn • TYPE OF . •V )R .) TlU~c1nN FED' SCHEDULE NNew construction Bt I ) m 1 I.vemolition For special information use checklist. Description l Qty. i Ea. I Total ID Addition/alteration /replacement ❑ Other: I New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 249.20 - and 2 family dwelling 0 Cotnmerciallindustrial 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 .70B SITE INFORMATION AND LOCATION Site utilities 5 Job site address: ` 5 S A, L ,�L LO FAL O U-0. s ..ti, Catch basin or area drain 16.60 City/State/ZIP: -T. l e A , t c ( O / ` c17 )-)- Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project na,k.iL {aci ?l Footing drain (no. linear ft.: ) Page 2 l Manufactured home utilities 110.00 Cross street/directions to job site: 1 Manholes 16.60 S4 S4.∎: 8 c_C -E- ` .)Q - ,'D Rain drain connector l 6.60 .∎: 8 - Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivisio f \.7')..* PACK( -G.. I Lot ,•-1 Water service (no. linear ft.: Page 2 Fixture or item Tax map /parcel no.: US s Absorption valve 16.60 . DESCRI LION OF WORK Backflow preventer Page 2 _2.7 S, i c.if)L - S el. ape irr/ O 0-17 /...,;;%) 0_f / >':.1- (1),,4., C : /(�', Backwater valve 16.60 i Clothes washer 16.60 Dishwasher 16.60 Drinking fountain D ' king f 16.60 "' PROPERTY.OWNR' E. `,L . :TENNT A Ejectors/sump 16.60 Name: b C I K)(.'l0 S S G 7 - i• HC r-' S Expansion tank 16.60 Address: 1 -7 4 a 3 _i .S L_L I ( ;w ( L.4_1 0 0CL, Fixture /sewer cap 16.60 City /State/ZIP:L a- -/ZC,. O. Lfi e' c 6 0/C Gf . 733 5 Floor drain/floor sinlc/hub 16.60 Phone: ( ) 1 Fax: ( ) Garbage disposal 16.60 APPLICANT CONTACT PERSON Hose bib 16.60 . -- Ice maker 16.60 Business name: 1 _,-,. /1 ,1 / f ^ /_ t✓ � -1 \ .�t 1 Interceptor /grease trap 16.60 Contact name: L 7 ,,. p c - 6-^,C; Medical gas (value: $ ) Page 2 Address: I a - J ,. �..) N ' (.,i,,c..' /vvl t .• r2D Primer 16.60 Ci /State/ZIP:1' / Y c / , Roof drain (commercial) 16.60 Phone: (5' (G' cJ - -5 % 5- I Fax:: (' o,') G, y�7 - 6 'f 6_, k Sink /basin /lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: _ Urinal 16.60 • CONTRACTOR 012 _ _ Water closet 16.60 Business name: fi.,>7G, - %.t; 07717 /JP't �) C. Water heater 16.60 • / -, -O / ) ( v ; ' ' /•` (�f Other Address: __ �� "� �'�� Subtotal City /State /ZIP: ; e. 7" ` C) ., 'l' � Minimum permit fee: $72.50, I Phone: ( e3) igQ,Q V a "Ca Fax: 503) 69;2 - 09 (Q E' Residential backflow minimum permit fee: $36.25 �F-' CCB Lie.: 7 aO n Plumbing Lie. no.: Plan review (25% of permit fee) Authorized siy:at ' t/ ) I State sur (8% of permit fee) 1 • VC ✓mil _ . Lrl I TOTAL PERMIT FEE 3 Print name /l /, a., , j`� J Da r ? c% S This permit application expires if a permit is not obtained '- irhin I30 days after it has been accepted as complete. 'Fee methodology set by Tel -County Building Industry Service Board. h\S l.dingtrerrniis \PIMP- PermitApp.doc 12103 140- 4616T( 10/02/COM/WP6B) 1 ' ci 89L0 Z69 -EOS uai i9 e6Zr60 SO 81 AON • CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 -00649 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/23/2005 Phone: (503) 639 -4171 Alb ��iipi�i Inspection Requests (24 Hrs.): (503) 639 -4175 s2 � _.. INSPECTION WORKSHEET FOR DATE: 11/29/2005 TIME: 7:05AM PAGE: 59 SITE ADDRESS: 15045 SW BLACK WALNUT TERR CLASS OF WORK: SUBDIVISION: SUMMIT RIDGE LOT #: 064 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE DESCRIPTION: Backflow presenter for irrigation. OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 -387 -75538 CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -6915945 Inspection Request Scheduled For: Date: 11/29/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 022554 -02 503- 692 -5945 N Corrections /Comments /Instructions: _ • ASS %] PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL % ' ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: . ` Date: 'hone #: (503) 718-