Permit k OF T
CITY O I 1 I GAR® PLUMBING PERMIT
r � I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00370
VI 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/10/2005
PARCEL: 2S 109D B -03600
SITE ADDRESS: 13018 SW HAZELCREST WY ZONING: R -7 •
SUBDIVISION: SUMMIT RIDGE LOT: 074 JURISDICTION: URB
Project Description: Installation of backflow device.
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 HOMES
4230 GALEWOOD ST Description Date Amount
STE 100 [UPLUMB] Permit Fee 8/10/2005 $36.25
LAKE OSWEGO, OR 97035 [UTAX] 8% State Sure 8/10/2005 $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: - ,2,/ AfiSC.€ Permittee Signature: _ Rs
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.
Building Fixtures .
Plumbing Permit Applic t� V E " FOR OFFICE, USE ONLY
Cit y of Tigard '} Received Z Permit No l l ^�
AUG � 9 � Dale y: �� d5 /) /70
13125 SW Hall Blvd., Tigard, OR 97223 [�� Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 I q' f'• Date/By: Other Pe 't No.:
24- Hour Inspection Line: 503.639.4175 CITY OF TIG A l l t ., •
pate Ready /ay: d See Page 2 for
Internet: www.ci.tigard.or.us Q . .;,
nl iii htntr _ Notified/Method: ` • pplernental Information
TYPE OF WOI21C ".vt°"" F i ." DULE
ew construction 0 Demolition For special information use checklist
\ \ \ \ \\ Description I Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
and 2- family dwelling ❑ 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
Fire sprinkler ( - sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / 30 / r Q (- /G(-2-1 ec.rt.- - � L L,a. - 1 Catch basin or area drain 16.60
City/State/ZIP: 7`l OR e 7 �-Lf l Drywell, leach line, or trench drain 16.60
g• /a t.
Suite/bld n o.: L Pro ject f �Q .CC >( �.. y
Footing drain (no. linear ft.: ) Page 2
P J name: d• �.UVI/'YI Lf" I '� {
Cross street/directions to job site: / Manufactured home utilities 110.00
/�
�" � - Manholes 16.60
r���� 'f t�'t) 6 e .c_ /e •Gi_ i • - /Cp A0 - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: ..Ljyl f'VL� �a q�j I Lot no.:'7y Water service (no. linear ft.: ) Page 2
l Fixture or item
Tax map /parcel no.: t A T Absorption valve 16.60
•
DESCRIPTION OF WORK Backflow preventer / Page 2 g7, SS
/ , � 4 a 1 , . e , , 1 / i 6 0./7 C7)') i U_G -r- /(f iJ c ' ',, , } i :- Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
IS Drinking fountain 16.60
PROPERTY, OWNER , .1 . ❑ TENANT'
Ejectors /sump 16.60
Name: 1) ci (3')(:)/7 S S iL 't` / e -S Expansion tank* 16.60
Address: t-f a 3 C ,s L 6j:- ( r' L,C) O O C / Fixture /sewer cap 16.60
City/State/ZTP:L..cs, c 0 Lei c' 7c, Q y 7 b 5 Floor drain/floor sink/hub 16.60
Phone: ( ) 1 Fax: ( ) Garbage disposal 16.60
Hose bib 16:60
‘&1 .CONTACT PERSON
Ice maker 16.60
Business name: 1.LL/ ( / co G/ l �C /
� �'' � �/ r.-->'i � Interceptor /grease trap 16.60
Contact name: d I , . f (4,,,-;k:674_1.) Medical gas (value: $ ) Page 2
Address: i 3 .a- /)0 _-.fE) i If� /Z.D Primer 16.60
City/ State/ZIP:°- 61_ J2. , J -70 ( ,-) Roof drain (commercial) 16.60
Phone: (Sri ) (� C/, - 59(/c- Fax: : (,5'',)) 6.' y ,31 _ C- 'A. ,�4.' Sink /basin lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
• CONTRACTOR Water closet 16.60
)3 usinessname:LE:Ln /'' asfzL, i� ? ^ ./2fj t - .L./ -i Water :heater 16.60
Address: / -� 0C. S /.r.J i;/1 j/ fJ% // 1. t-! Other:
City/State/ZIP: � `� -4706, Subtotal
Minimum permit fee: $72.50
Phone: (3) j .5'. 5 Fax: (503) ( 9c ? -- pr] (¢ g'. Residential backflow minimum permit fee: $36.25 , -
CCB Lie,: 7 an re view ( of permit
/RO- .
�(,y Plumbing Lic. no.: Plan 25% f it f
�
State surcharge of per fee) Lt�
Authorized signs p
Autho °y "
n Lt C &
® 'Z �! z'</ - TOTAL PERMIT FEE .39, !S
Print name 1/ et') � ,r 7 -7._✓`% Datgq lo ,c This permit application expires if a permit is not obtained ithin
D L t 180 days after it has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board.
i•Unuilding \Permits \PLMF- PermitAppdoc 12/03 440- 4616T(10/071COt /WEB)
2' d 139LD- 269 -EOS uaii3 eSO =TT SD 60 2nd
CITY OF TIGARD
IGARD
BUILDING DIVISION - • PERMIT #: PLM2005.00370
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7:06AM PAGE: 24
SITE ADDRESS: 13018 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 074 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of back low device.
• OWNER: DON MORISSETTE HOMES, PHONE #: 503 -387 -7638
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 8/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013837 -02 503- 692 -5946 I+!
Corrections /Comments /Instructions:
•
•
M- ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
E FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 2/U Date: 1 Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: Pf M2OO5 00370
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 AO-
INSPECTION WORKSHEET FOR DATE: 8/18/2005 TIME: 7 :06AM PAGE: 25
SITE ADDRESS: 13018 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 074 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of bacldlow device.
OWNER: DON MORISSETTE HOMES, PHONE #: 503.387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 8/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /bacl4low presenter 013837 -01 503 N
Corrections /Comments /Instructions:
•
4•••i ,
, „it
•
S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ri Date: 5/72,4_ Phone #: (503) 718-
.