Permit CITYOF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00618
`' All DATE ISSUED: 11/2/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DB -03500
SITE ADDRESS: 13050 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 073 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 SUITE 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 11/2/2005 $36.25
[TAX] 8% State Surchan 11/2/2005 $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: / /1 Permittee Signature: G
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.
id. g Fixtures
1 ' 1 l f 4 A 1 m p ll ll c : .011 N �-
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Received
- -- - -- _.. .
C'Ity of Tigard
13125 SW Hall Blvd., Tigard, OR 97223 ( ° 4 \- , Date/)3y: �I /�QS' Pcmut No� �
V4
Phone: 503.639.4171 Fax: 503.598.1960 1 v � Plan ltavie o, _co O
•
24- Flour Inspection Line: 503.639.4175 �0 Z i, 1 i • \ Date Rea .
y: Other Permit No.
• Internet: ww.ci.tigard.or.us - � 1 � Y 7✓ -r - Date dfMeth '• I See Pa e
\v � V �• r\�� w Notified/Method C 6 • 2 ror
r1 S tntbrmation
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_ _ FEE* sort •.ut,i_�
New construction lition For special information use checklist ❑ A dition/al[t ration/replacement TelPE or W77:::: Description Qty. Ea ? Total _
_ New 1- 2 - family dwellings (includes 100 ft. for each utility connection )
1-
CATEGORY OF CONSTRUCTION
r _ SFR (1) bath
?49.20
and 2- family dwelling CI CommerciaUindustnal SFR (2) bath
❑ A cessory building • SFR 350.00
❑ Multi - family ❑Other: (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
7033 SITE : it ^ OI2MA ?'f(3N • AND I LOCATION Fire sprinkler ( sq. ft.) Page 2
•
Site utilities
Job site address: f 3 O ® S w f _�tLZ Y�L� a -
f W� Catch basin or area drain 16.60
City/State/ZfP: •7 / a at_ �' 1 2. -C-if Drywell, leach line, ne, or trench drain
7 16.60
Suite bldg- /apt. no.: Project ntt� Footing drain (no. linear ft.:
,34;.4 , me___ ` ____„ d_yam. 7-3 - ) Page 2 1
Cross street/directions to job site: Manufactured home utilities 110.00
P(,() i C 6 ,f- a..e- rt_e -C_ 02 Manholes 16.60
/C {3 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Wit- Z;C� � I Lot rat 3 Water service (no. linear ft.: ) I Page 2
Tax map /parcel no.: ( S ,..4. Fixture or item
1 DESCRIPTfON OF WORK Absorption valve f 16.60
i _ -.. Beddow preventer • i Page 2 ;1- • S S
Jri /'�`� + (� \•� _i'/,LZ: ft/ 1 //; / ^ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
-- 1� Pt` * - 1 . i5WNER- : . I . Drinking fountain
;� ❑ T'ENAN'T 16.60
Name: J /1-n ,dn7) - vi S S i ! -r• /� C� Ejectors /sump 16.60
Address: Expansion tank 16.60
Z 3 L ' S 1�4 6-- e t j O C , C Fixture/sewer cap 1 6.60
City/State/ZIP:L • ., / C L 0 c J e'� 0g._. t-/ 7 a S Floor drain/floor sink/hub 16.60
Phone: ( ) J Fax: ( ) Garbage disposal 16.60
_al >I>1,)iCA,`IT • C7 ":ACT PERSON- Hose bib 16.60
ksttsiness name: �f , i /: / ' L � „, /: -- - Ice maker 16.60 I
.• e ei J v ^, r,--; JJJ
Contact name: Interceptor/grease trap 16.60
J c,,,-.) p ^ �d V � Medical gas (value: $ 1
.Ad .�� i J C 6 t ) Page 2
• Ui' 111 _ -; /rn L; J21) Primer 16 60 J
City /State/ZIP: , • a at_ 1 _
�� � �- • lf`�- , c: 2 , j �C {‘? ,.,Z Roof drain (commercial) 16.60 II'
Phone: (50 / 9.;-4 - S c./ C C...; '1.,,,11>
Sink/basin/lavatory I
Fax: (S'3) c Y�1 - ry 16.60
E -mail: Tub /shower /shower pan 16.60
_ CONTRACTOR _ - Urinal 16.60
�-" -- Water closet 16.6D 1
Business name :, G _S e. �. r �0 a ��ri Water heater
7 J t. 02.--e , 16.60 1
Address: y -G y y
✓° S ! dJ ;M\ t :1 • y /•;y1,.tJ /2.0 Other:
City/State/ZIP: ", , 7 _, (- /_
" �f <'�i�i ,�' - Subtotal
Phone: (ci =3) tfe<Y t_'1 jC f/
Fax:) � ��' 0 7 g . Minimum permit fee: $72.50
,Q - � (,c% � Residential backflow minimum permit fee: 536.25 3e,; oZ
e • .S
CCB Lie.: 7 e oy R Plumbing Lie, no.: • Plan review (25% of permit fee) 11
i
Authorized stgnatyrt i /J ,•, z /i " I State surcharge (3% of permit fee) I 0.. , 90
Print name:!' ` 1 TOTAL PERMIT FEE�� f S 1
J- - • i� l �� :' "A; `s.`�, 1 Datl /_/ - OS I This permit application expires if a permit is not obtained ".:?thin
180 days zfter it has been accepted as complete.
: \Buil ding \Permit !AP LMF - Permit App, doe 1 2/03
*Fee methodology set by Tri- County Building Industry Service Board
440- 46 16T(10 /02 /CO\1AVL'BI
.17'd 89L0 269 - EOS uai e,y2 =80 SO TO now
' CITY O'F TIGARD
BUILDING DIVISION PERMIT #: PLM2005 00(x18
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 1//202006
Phone: (503) 639 -4171 ■' d gpu� i f p
Inspection Requests (24 Hrs.): (503) 639 -4175 .�!�!��- ,- I..
INSPECTION WORKSHEET FOR DATE: 11/9/2005 TIME: 7:09AM PAGE: 71
SITE ADDRESS: 13050 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 073 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Back?low preventer for irrigation.
OWNER: DON MORISSEI IE COMMUNITIES, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
Inspection Request Scheduled For: Date: 11/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
•
399 Plumbing final 020690 -02 50: -692 -5945 N
Corrections /Comments/ Instructions:
/))
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 7 Phone #: (503) 718-