Permit CITY TIGARD PLUMBING PERMIT
q ua l DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00693
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/16/2005
PARCEL: 2 S 109 DA -11600
SITE ADDRESS: 12989 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 105 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 12/16/200`. $36.25
[TAX] 8% State Surcha 12/16/200e $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: l > Permittee Signature: . s ! � c , . n
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.
Bit Fixtures ��
Titumhing Permit .App1ica ( .i k t 1 .. .. FOR OFFICE USE ONLY
City of Tigard Ren - ...,',......241.0 Permit N 4......,/ 4 ' d 93
13125 SW Hall Blvd., Tigard, OR 97223 DEC 1 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /lt , i111ry;,,,.: 11) t\ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 t'll 1 Date RcadyB 1a y: /� a See Page 2 for
Internet: www.ci.tigard.or.us Ci ( » • i •l t Not d. : V Supplemental Information
TYPEaF e � FEE* SCHEDULE
a ° 1 Y � Oj�?
For s information use checklist.
New construction
El Demolition
Description I Qty. I Ea. 4 Total
❑ Addition /alteration/replacement ❑ Other: New 1 -2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commerciallindustrial 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 INFORMATION AND LOCATION . Site utilities
Job site address: /). C7 gcf s L{,l )a ev ',oat t,( „CT Catch basin or area drain 16.60
City/State/ZIP: T/ cf CL & a_ el, '7 7 a-d- Li Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project namgLL M L ' et9E• 1 0S l Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110,00
Cross street/directions to job site:
B n Manholes 16.60
O
S Lo • e B- eric.1 fi_/, Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisior4 LLl y) LI- pi. c 9 e Lot no/OS Water service (no. linear ft.: ) Page 2
Fixture or item
' Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2 a 7, S
�'.n':,:i.c.,..! fie, /rr/ (7(/_t' 03 )C /.e'-(tr•77e7/. XI . ( / „� , Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
El_ PROPERTY OWNER . . . . I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: D C ;.) /"/) („Y/ S S L f• 7 f ) e. J. Expansion tank 16.60
Address: L-L, 3 L' S U..._.} Glc (c'- F.-10 U ()tit Fixture/sewer cap 16.60
City/State/ZlP: LCc.. c 0 K Lt.: C 41C> G k. 4/ .7 (:=3 S Floor drain/floor sinlc/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
• 'R APPLICANT : `JCONTACT PERSON •
Ice maker 16.60
Business name: Lail et S d /_t/ `0.,::, / //7of un �.i Interceptor /grease trap 16.60
Contact name: / . t l .., r o ( / j-y .J ,� ^ Medical gas (value: $ ) Page 2
Address: / . ()
- 0 � U) 'e° ; v ; in L., t z,0 Primer 16.60
City/State/Z1P: ' J -J �" • Roof drain (commercial) 16.60
_
�. � /� G Sink/basin/lavatory 16.60
Phone: (S6 ,_3) iL /• - S/ (/ . c � _ Fax:: (L,- (�, `, v2 7!,' .v
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: ./, Ln a_S ( LL t J .c., 0 o-73 n� v�� G Water heater 16.60
Address: / �-�- S GG I .) r `!•� - !6:'. t-1 :"`.4% Other:
Subtotal
City /State/ZIP: 7i„ €.6i j Cie._ '4'7 Minimum permit fee: $72.50
Phone: C:50 _3) (gQ �y � s Fax: 603) e..6, cf't 0 ? (p g. Residential bactcflow minimum permit fee: 536.25 3 ( - °Z S
CCB Lic.: 7 21' C_ 0 Plumbing Lic. no.:
Plan review (25% of permit fee)
State surcharge (8% of permit fee) e , %C
Authorized signs ��Q/� ��� TOTAL PERMIT FEE 3 �/, /S
Print name, a eel •c �
a,, -- n � Day? _/ /(i / c7 This permit application expires if a permit is not obtained i' ithin
�" l 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i\Bui Min g \Parnits\PLMF- PcrnitApp.doc 12/03 440- 461fiT(10/02ICOM/WER)
T'd 89L0- z69 -EOS Ua113 eZOt6O SO 9T 0911
.... , .
CITY OF-TIGARD
BUILDING DIVISION PERMIT #: PL.M2005-00693
! 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 171 1 612005
Phone: (503) 639-4171 ,...741111111-:
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/70/2006 TIME: 7:00AM PAGE: 88
SITE ADDRESS: 12989 SW BLACK WALNUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 1Q5 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSEITE COMMUNITIES Lie, PHONE #: 603,381:638
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: fa:3-692-5946
Inspection Request Scheduled For: Date: 1/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
. . 399 Plumbing final 025350-01 503-692-5945 N
Corrections/Comments/Instructions:
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l l FAIL 7 CALL FOR INSPECTION n ADDITI NA FEES ASSESSED
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Inspectcir: Date: ( ZO Phone #: (503) 718- 242-3