Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00514
��' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/4/2005
PARCEL: 2S 109DA -11500
SITE ADDRESS: 12999 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 104 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 Description Date Amount
4230 GALEWOOD ST. STE 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 10/3/2005 $36.25
[TAX] 8% State Surcharl 10/3/2005 $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 Muniapal 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 -66 or 1- 800 - 332 -2344.
Issued By: ,o -7 Permittee Signature: /`(.1'
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 „i
1
,, updkr g !F1 ;,:�'r!I!li s
1E i e9••:lu .:C A.r i }plvt kJ
l 1 .. %VED FOR OFFICE USIE UNLY '
City of Ti ll arrd 200 4
Received /
n �,
13125 SW Hall Blvd., Tigard. OR 97223 ®( 3 Date/By: 0 h • Ml, v , / 0 `0D 57
ll++ Plan Review
Phone: 503.639.4171 Fax: 503.598 - 1960 ;:, a Other Permit No.:
24 - Hour Inspection fine: 503.639 4175 __ � �� 1 6 - ; i t - y ` D ale Re /B y lur �' _ [7J S Pa ge c 2 far ■ Internet: www.ci.tigard.or.us CITY OF Tt 1 G ,, ' + Notified/Method: �� Supplemental Informa
TYPE: � FEE SC(tt• :t)ULF
For special information use checklist.
New construction ❑ Demolition Description Qty. ! Ea. Total
❑ Addition lerationireplacem nt ❑ Other: ! New 1- 2- family dwellings (includes 100 ft. for each utility cenreetio:1)
•(::>,'1'I;tiOR`f OF CON STRCiC:TION SFR (I) bath 249.20
I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
I=1 Accessory' building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/kitchen 45 00 —
_.... Fire sprinkler ( _ sq. ft.) Page 2
.JOH SITE INFORMATION AND LOCATION _ _ Site utilities
Job site address: /,7 5L. 6 /GL C4- L occouLr' 4. - Catch basin or area drain 16.60
City/State/ZIP: _._..... __._. ._ _._ ' 7 Drywell, leach line, or trench drain 16 -60
Suite/bldg.. no.: — � Project nam i.4. vn•1/'il_2_, Je-ziq Footing drain (no. linear ft.: ) _ Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Ea fi < -•L • g Rain drain connector 1 6.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
n <" � Lot no1:b I Water service (no. linear ft.: )
Subdi visio Page 2
i Li rlC)'z T ti �C.
r Fixture or item '
•
Tax map /parcel no.:
�?% �� 5 ._ f _ Absorption valve 16.60 1 _
DESCREPTTOi1 OF WORK �
__ Backflow preventer / i
Page 2 S
/
.. - _57 /(. -..,/ !-! , , ii /,i_r : i "' i. 1 fl
�,. i ' 0L� 1 �
I :; e d Backwater valve 16.60 1
Clothes washer 16.60
Dishwasher 16.60
• ® PROPERTY OWNER l Drinking fountain 16.60
❑ 'TENANT
• Ejectors /sump 1 6.60
Name: / /, -,.. ..,-.,-)/...:„., . - . /.::,,:-_,,-,....-, , ;�
Expansion tank 16.60
Address: zit . 3 C,. .% :.. ;_ : " .. ( c C; (' "(L Fixture/sewer cap 16.60
City/State/ZIP:/ l'. ■, -: \ /a Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
- . .---- Hose bib 16.60
'• Al ' id( :ANT _ .'Fl CONTACT. PERSON
— _....— _- _......_. � _— [cc maker 16.60 L
Business name: i - -.(i ' % 0.. . !.;:•,-:(; / , s, 1 ._/�.,
r � [nterceptor /gteasc trap 16.60
Contact name: L ;,• :). : • r, -;')\ Medical gas (value: $ ) Page 2 •
Address : - • 1.:.• ' I ; t. ' ( i / 'i , - i �. ;i Primer 16.60
City/State/ZIP: '' /: , 7 7/ . ■ , Roof drain (commercial) 16.60
� , Sinklbasin' lavatory 16.60
Phone: (S%' �i) °e:. </ .. : ..- : y . I Fax:: (. ±,' j 7 Y ) - - ",
l — )(r_ -_
— — Tub /shower /shower pan 16.60 1
E -mail:
— . —. --. - -- __ Urinal 16.60
r
r :(E,,TIZACI•Ult Water closet 16.60
Business name:/ , i , 0 ; - - / . 0 . ; - - . . . - >- - -- Water heater i 16.60
I
Address: f"_ n ,. "_, Other:
Subtotal City /State /ZIP: ° /' , — ` ,`��
- - -- -' l .. Kd _ Minimum permit tee: $72.50
Phone: (''',54., - i,) f!• !; ' ':!" •• Fax: (` .9. -) 6,9Q -. 076, g' Residential backflow minimum permit fee: $36 25 31,, • Q S
Plan review (25% of permit fee)
CCB Lic -: q' I Plumbing Lie. no.:
— —' ,`-• State surcharge (8% of permit fee) - y 0
Authorized signal rti i 1
�_ ! _. _ i :'� "%' Vi a/ TOTAL PERMIT FEE I ,is }
print name / i v ,•• ` D 1e / j This permit application expires if a permit is not obtained s ithin
- -- --- 180 days after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
is \puildinG\YumitaTU,1I App dv: !_ ; ::t 440- 4616'r(I0 /02:COM/WE0)
•
I' 89L0 -269 -COS u e8T =80 SO 'CO 400
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00514
13125 SW Hall Blvd., Tigard, OR 97223 , . DATE ISSUED: 10/4/2005
Phone: (503) 639 -4171 av �o�iu �'i�r'l
Inspection Requests (24 Hrs.): (503) 639 -4175 .J■ - "-__
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7:08AM PAGE: 78
SITE ADDRESS: 12999 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 104 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Baclflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES, PHONE #: 503- 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503- 692 -5945
Inspection Request Scheduled For: Date: 10/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 017935 -02 503- 692 -5945 N
Corrections /Comments/ Instructions: Oil"'
T-2S lc-:, t ---0 —
•
r '
l
♦ •
r ,
e,,,...
/ ! M ';. .
r.
s,
.jy
t ,°
,.,
PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
\z() Inspector: Date: / / Phone #: (503) 718-