Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005-00648
�I DATE ISSUED: 11/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109DB -02400
SITE ADDRESS: 14995 SW BLACK WALNUT TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 062 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
4230 GALEWOOD ST SUITE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee • 11/23/200: $36.25
[TAX] 8% State Surcha 11/23/200E $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
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: a .
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.
Buiidiffig FIXtE2 - es
'ID1']s 7nbJJ ffig Permit A m i; ll Ire igi� V 1•j r
city ®1F ° ._ . ' . i I MF E BOO Nj'ys "?:4a *', 1 :;
• Tigard ! ive • • 7 _
13125 SW Hall Blvd., Tigard, OR 97223 mr' J 2 ' �oo oPermit N Phone: 503.639.4171 Fax: 503.598.1960 1 V " ° � Rc
" !t� Other Permit No.:
r • > wd ' 3E Date/
Bs Hour Inspection Line: 503.639.4175
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Internet: www.ci.ti rd.or.us Y O �I
F T IGA Ra�
- .e:sq.e. : •, Date Ready/By: 3 '.. ) ® See Page 2 ter �
nu\ i(^ nl \jlS U. Notified/Method: .. (
/
oo�� l-7 1v-� 1 SupplernentatInrormatin
TYPE+' 'Jt1 WORK FEE* SCEtED VLI,
N IN s i\lew construction ❑ Demolition For special information use checklist.
1 ❑ Addition/aiteration/rcplacement Description Qty. Ea. Total
❑ O ther: _ New 1- 2- family dwellings (includes 100 ft. for each utility connection
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
1Q 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ building C:1 Multi SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
' Fire sprinkler ( sq. ft.) Page 2
• • JOE. SITE INFORNMATION AND LOCATION
Job site address:1 s .
Site utilities
• � tl5 � 9 �� � �•� -�. L � G� (��' .� Catch basin or area drain 16.60
City /State /ZIP: 7-'i 4 i L �, L C ' f 0,e_ c/-•J Z
' f Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt- no.: / Project na n : JJy) p f) u p R.4 aft Footing drain (no. linear ft.: ) ' Page 2 Manufactured home utilities 1 10.00
Cross street/directions to job site: y� Manholes 16.60
£ i CL' Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ ) Page 2
� � � Storm sewer (no. linear ft.: ) Page 2
Subdivision:.3J.LL.rf m II_d qj' I Lot no.:�7 -,._ - Water service (no. linear ft.• ) Page 2
Tax map /parcel no.:( �S 14 /) Fixture or item
/ Absorption valve 16.60
DESCRrPTION OF WORK
p t Backflow preventer / Page 2 7 . S
F �L.a jo _s, ( L)(..• / r 0 ca f ; !Je } /I_Cy?'C - jL'uj c. Backwater valve
e %i, t' 16.60
Clothes washer 16.60
Dishwasher 16.60
'•Q OPERT Y. O W1Y1EIt. Drinking fountain 16.60
R S .. , 0 .TENANT •
• Ejectors /sump 16.60
Name: DO-Y1 0)0Y/ Y/ S S (_-_-7 i• /rte,') e S
Expansion tank 16.60
Address: /- f a 3 o S Lki 6a<<j e L C 0 oc.'
(: Fixture/sewer cap 16.60
City /State /ZTP:L. 3 ke [). Lt,J.c /C 0 k. G f / U. <3 S Floor drainlfloor sink/ 16.60
Phone: ( ) F ax: ( ) Garbage disposal 16.60
APP1 IECANT Hose bib 16.60
.. CONTACT PERSON
- Ice maker
�1�/n i1' , - e! ^. C<�, --_. / .�,� 16.60
Business name:
1 1
Contact name: Interceptor /grease trap 16.60
� ?! '. S PL �':� -c
Address: t Medical gas (value: $ ) Page 2
- 3 DU <. g
i ✓'� . � �j .,� -:� ('I 11 Lr (Z Primer 16.60
City/State/ZIP:.---p, /Li a m b 2 , - 7 - » -, (c `l Roof drain (commercial) 16.60
Phone: (5 l 3 ) (G 9,.;? - S Fax: : r . , Sink/basin/lavatory 16.60
E-mail Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet
Business name: / i 16.60 I
f- f.../i -S ez _ i •c - r. /(j21 Z ) C, Water heater 16.60
Address: /' �:�-OG /,+� pp, L , i vy � , Other:
City /State /ZIP: �°J� ��-� -',01z 'et/70( Subtotal
Phone: /t Minimum permit fee: $72.50
�3) 7� S W C, (. Fax: 603) 69,; .. , O7:; E Residential backflow minimum permit fee: 536.25 .4..-, : a_s
CCB Lic.: 7 gU 11 Plumbing Lic. no.: Plan review (25% of permit fee)
/
Authorized sig:,a i 0 State surcharge (8% of permit fee) , 'ct Li
�/ _ ' 1 - ��� �+ I3 j
1
TOTAL PERMIT FEE e1 /
Print name .� /,/ ) ,_S: _ a, -�?; aj• :/ 2-- This ermit a application expires if a permit is not obtained ��
�/ �� ) D •- permit PA P� P ch in
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
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a' d 89L0- Z69 -EOS ua t l3 eG : 60 SO et AQN
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00648
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/23/2005
Phone: (503) 639-41i1 '
...
Inspection Requests (24 Hrs.): (503) 639-4175 & J"
INSPECTION WORKSHEET FOR DATE: 11/29/2005 TIME: 7: 05Alvi PAGE: 57
SITE ADDRESS: 14995 SW BLACK WALNUT TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 062 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSE! !E COMMUNITIES, PHONE #: 503-3t7-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 11129/2005 Pour Time:
•, Code # Inspection Description Confirm # Contact # Message •
. 1
399 Plumbing final 02255502 503-692-5945 N
Corrections/Comments/Instructions:
•
Cikif •
p i ...i PASS L l i ARTIAL APPROVAL El CANCEL El NO ACCESS
EI FA L C A -
SR INSPECTION F I ADDITIONAL FEES ASSESSED .
/
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Inspecto : _Al 1 -411111111111111111■ Date: —72 ' 67 - 21 Phone #: (503) 718-