Permit , • •
A , CITY O TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00217
°I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2510 005
PARCEL: 2S 109DB -03700
SITE ADDRESS: 12996 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 075 JURISDICTION: TIG
Project Description: Irrigation backflow.
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 Description Date Amount
4230 GALEWOOD ST
STE 100 [PLUMB] Permit Fee 5/27/2005 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 5/27/2005 $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 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: qmp. Permittee Signature: l 0,7f70_12, . r ( y ,
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 5-1)
Plumbi Permilr pl bation FOR OFFICE USE
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City of Tigard c �2op5 Received
13125 SW Hall Blvd., Tigard, OR 97220 F `- ' Date/By: „ 5: ( /)-7/05" /36 Permit No.: o G (�( /
n pHi
Plan Revie
Phone: Hour Fax: 3.598.196Q F T \GR t} :h'i l,.. fj y...,:..... '' D ate/By: Other PermitNo.:
24- Hour Inspection Line: 503.. 639.4` { '�w e�,� t. t ..a - Date Ready/By: y: / t EI See Pa e 2 for
Internet: www.ci.tigard.or.us t Ft n1kA Notified/Method: / Supplemental Information
. Ka.,t . , ., /�
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TYPE ".O WORK lF * se FI37DTJI E
New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 Addition/alteration /replacement p Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CAT OF :CONSTRUCTION ' • • • SFR (1) bath 249.20 •
1- 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 OF AND LOCATION Site utilities •
Job site address: ia . 91(„, irtU b .uCC
Catch basin or area drain 16.60
City/State /ZIP: Ti l CiC/ a_ 0 •..- c -7 „ ?.?_ ... a Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no.: Project name: Su1 ,- P.-edge..., /7.g. Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
S (k) 6 G e_ 6.e_eA_. -6 - Manholes 16.60
Ram drain connector 16.60 {
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Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
(� I 1 S Water service (no. linear ft.: ) Page 2
Subdivision:
cS(•Iryl rvl t /Q- ow Lot no.:
Tax map /parcel no.: 5 17 Fixture or item
Absorption valve 1 6.60
DESCRIPTION OF WORK Backflow preventer / Page 2 0.7 . SS
-Sl r / Gc CT) ; o / c/ . 0 / a2 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• O PROPERTY OWNER. Drinking fountain 16.60
LI TENANT
Name: Ejectors /sump 16.60
UCPi 1 rno SS e_'f'-� f G3'� ,e ms Expansion tank 16.60
Address: Z-7 3 p w c . -( 4 A-0 0 OCL Fixture/sewer cap 16.60
City/State/ZW:La_ Q C, Q S sue' t,t�� Qg_ -10.3 5 Floor drain/floor sinlc/hub 16.60
Phone: (. ) / Fax: ( ) Garbage disposal 16.60
. APPLICANT • : CONTACT PERSON .• Hose bib 16.60
• Ice maker 16.60
Business name: l_,_, E �^� Dreg an 2e1 C Interceptor /grease trap 16.60
d /
Contact name: fw ,Sip C@.t�r�Z� Medical gas (value: S ) Page 2
Address: 1 - -C , 0 A, Inv � l(f j 1W Primer 16.60
City/StateJZlP: 3 f 1) aM� / o p . _ , � 70 (0 D-- Roof drain (commercial) 16.60
( S03) � -.9(/S (5 ) 6 Y� 76, Sink/basin/lavatory 1 6 . 60
Phone: Fax: _
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
I .
Business name: / S s p.0 O qo7- c Water heater 16.60
Address: / ? � m uS/r gip Other:
City/State/ZIP: `7i - )rt `J -4 70� Subtotal
Minimum permit fee: $72.50
Phone: (5C).3) (eQ6/ SW Fax: (03) 6r'a e O'76, g' Residential bacidlow minimum permit fee: $36.25 to ' --S
CCB Lic.: 7 g-U Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sr p ) State . - 12 o (8% of per fee) q I
t TOTAL PERMIT FEE I 39 / SI
1
Print name.0 e Dat 1. - This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Buitding \Permits1PLMF- PemtitApp.doc 12/03 440 - 4616x(10 /02/COM/Wne)
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CITY OF TIGARD
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BUILDING DIVISION PERMIT #: PLM2005.00
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/27/2005
Phone: (503) 639 -4171 � '� '" 01 0���� i�gIP I A\ a 1
Inspection Requests (24 Hrs.): (503) 639 -4175 1 �I
INSPECTION WORKSHEET FOR DATE: 6/6/2005 TIME: 7:13AM PAGE: / 94
/ SITE ADDRESS: 12996 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 075 TYPE OF USE: /
1 PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Irrigation backf low.
OWNER: DON MORISSE! I E HOMES, PHONE #: 503-387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503. 692-5945
Inspection Request Scheduled For: Date: 6/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 008434 -01 503692 -5945 N
391 ?L ■(-2 .....- - —a'
Corrections/Comments/Instructions:
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)VIDASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: Date: lc( Phone #: (503) 718 -