Permit CITY TIGARD PLUMBING PERMIT
N,, I4, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00200
All DATE ISSUED: 5/11/2005
'`' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DB -02700
SITE ADDRESS: 13089 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 065 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 COMMUNITES LLC
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [UPLUMB] Permit Fee 5/11/2005 $36.25
[UTAX] 8% State Sure 5/11/2005 $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: . Permittee Signature: S_ -L c.)
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.
J
i
Building Fixtures
Plumbing Permit Applic ti r I 4) FOR OFFICE USE ONLY •
City of Tigard Received r Petrnit N� ;
DateBy:.) if vi m „..7-1......../ ? \ �j a io
13125 SW Hall Blvd., Tigard, OR 97223
' MR 1 O 2 '.:j Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 %sri, \ Other Permit No.: ,
hri�Yl� ( Date/By:
24 -1 Hour Inspection Line: 503.639.4175 n "r"--1 • �. �' Date Ready/Ey: v Se Page 2 for
Internet: www.ei.tigard.or.us CITY OF TI Notified/Method: A 1 ppt information
• TYPE' p b .1t G DIVISION.. .• .. . FE *' SC ULE
For ecia! information use checklist i
b ew construction ❑ Demolition P f
Description I Qty. I Ea. I Total
O Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
'CATEGORY, OF. CONSTRUCTION • • SFR (1) bath 249.20 •
SFR (2) bath 350.00
399.00
1 -and 2- family dwelling ❑ CotnmerciaUittdustrial ( )
ccesso building SFR (3) bath
❑ ry g ❑ Multi- family
• Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
:IOBJ SITE, INFORMATION AND LOCATION .
Site utilities
Job site address: f 30 C7 _Ea) lieu- /orSj Catch basin or area drain 16.60
City/State/ZIP: 7 j gj/ L� 0R 9 7 a' Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: � Project name t Footing drain (no. linear ft.: ) Page 2
Sil.rn rvl. (�rdy �S g
Cross street/directions to job site: Manufactured home utilities 110.00
^ e ^ - _` Manholes 16.60
S W C
_-- /�' -�tK.. As, - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisions rn r6 G '( c , ( Lot no.: OS- Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: CDS- S Fixture or item
Absorption valve 16.60
DESCRIP OF WORK Backflow preventer f Page 2 , L7 ,SS
L- 4SC ctee, /rr/ C/ a 0 /)G2,ck f1cui �f, y /lam Backwater valve 16.60
t Clothes washer 16.60
Dishwasher 16.60
'` QPROI ERTY • QWNER: ,: - ,,❑ , NANT: Drinking fountain .
Ejectors /sump 16.60
Name: b :)1 61 C)Yl S S c_74-4- f-/0 eS
Expansion tank 16.60
Address: I 7 1 3 () S Lii 6 Ge_ - ( e t.c 0 6L Fixture /sewer cap 16.60
CityIState/ZIP: j _(3t e OE w e . y'o OA 9 - 703 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
ose t
H b•b 16.60
. Pi.FI;ICANT';. ' . ....'. CONTACT : `.
Ice maker 16.60
Business name:
L J) a E e_eL - OY c / .ip'a interceptor /grease trap 16.60
Contact name :! e zr (err Medical gas (value: $ ) Page 2
Address: / 2-D-00 ,.(j) rnv- S-llm� 2) Primer 16.60
I
City/State/ZIP:' -p I Q . &h� OR_ , �- 7G � Roof drain (commercial) 16.60
Phone: (O3) .G) g ; -SY(/5 Fax: : (5 6 Fa - G 7e Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR - Water closet 16.60 r
Business nazne:Lc .9 - -� G Water heater 16.60
Address: / ,2' -QG ,S mil,S4e5 g Other:
City/ State/ZIP: OQ 7O& Subtotal
Minimum permit fee: $72.50
Phone:6v3) foQcQ .S-9fg Fax: 603) 6, 9.? - 0767 e Residential backflow minimum permit fee: $36.25 .3 in- 2.s
CCB Lic.; Phfm bing Lic. no.:
Plan review (25% of permit fee)
Authorized signa State surcharge (8% of permit fee) .. 4a
TOTAL PERMIT FEE T /5
Print name8 Date j d l Q S This permit application expires if a permit is not obtained within
l 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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