Permit •
CITY TIGARD • PLUMBING PERMIT
DEVELOPMENT SERVICES
PERMIT #: PLM2005 -00372
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`"� j 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/10/2005
PARCEL: 2S 109DA -07800
SITE ADDRESS: 14996 SW HAZELCREST TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 055 JURISDICTION: TIG •
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 Description Date Amount
4230 GALEWOOD ST
STE 100 [PLUMB] Permit Fee 8/10/2005 $36.25 .
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcha 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
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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.
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Issued By: j.) �� �/ _( dam Permittee Signature: (� p
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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.
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• Building Fixtures
Plumbing Permit App on ��� • FOR OFFICE USE ONLY
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City of Tigard t•1 p� �1 Receive
o _ /� Permit N. o.:
� A Date/By % U� 1 \ b`<JO.� �O / I
13125 SW Hall Blvd., Tigard, OR 97223 0
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 � Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 QF T� y �;. ' I�
Ci�T Date Read /e luri
�+ , :., . ,..� Ready /By i El See Page 2 far Internet: www.ci.tigard.or.us .a ir` nivtt 'J" Notified/Method: �l k Supplemental Information
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TYPE OF W FEE* SCHEDULE
New construction ❑Demolition For special information use checklist.
\ \ \\ Description I Qty. I Ea. J Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath I 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
P AZcessory building ❑ Multi- family SFR (3) bath 399.00
E1 Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2 I
JOB. SITE INFORMATION AND LOCATION • Site utilities I
Job site address: /' L 9 �t rto // Z2 '
/ [ (yL ST coati
Catch basin or area drain 16.60
City/State /ZIP: '7) 9. C�CC 0 9 7 � D_y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project na Jam yl i
,-- /a a'q Footing drain (no. linear'ft.: ) Page 2
Cross street/directions to job site: 7 Manufactured home utilities 110.00
�J /� , J Manholes 16.60 '
- , geC1 luLI\..C( Rain drain connector 16.60
Sanitary sewer (no. linear ft,: _ ) Page 2
' Storm sewer (no. linear ft.: ) Page 2
^ �1 , „ yi , , �//��� Water service (no. linear ft.: ) Page 2
Subdivisro 1� C(it Lot no.:s
Ta map /parcel no.: S S Fixture or item
x
Absorption valve 16.60 I
• DESCRIPTION OF WORK
Backflow preventer f Page 2 a-7. 5
,l t..,✓; &I S( / rr/ ( /1L t' haaf?" 7 / fti)_`') 6 ; am. Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 16.60
PROPERTY.. OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: J e--)n tnt y/ .s s c_ • f h ' e j Expansion tank 16.60
Address: , 3 C. -. L.4.__ le ( C 0 °CC. Fixture /sewer cap 16.60
City/State/Z1P :lam k C L; _S LU ey6 C /`. / 7 LS _� S Floor drain/floor sink /hub 16.60
Phone: ( ) / Fax: ( ) Garbage disposal 16.60
APPLICANT CONTACT PERSON Hose bib 16.60
Business name: L_C ; � Ice maker 16.60
C i �( '' fit. " e / �� j Interceptor /grease trap 16.60
Contact name: - 'J 3 ' t
CL) Medical gas (value:.$ )• Page 2
Address: P - 0 , ) rr i GI Y S_.f 1V,t L � Primer 16.60
City/State /ZIP: lL .1_ f: �L Roof drain (commercial) 16.6
A.. , �2. , � I - 7 C
Sink/basin /lavatory 16.60
Phone: (0e Cc' /.:-? - SI vS Fax:: (.5 o Y:�l - (, , ,7 - S'
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
• . Business name: cl (Zli //1.f a: 07 Z •!t r Water heater I 16.60
Address: / 3-x-00 S ('J) nil Li .S.I Jy t.! 1?-0 Other:
City/State/ZIP: 7ii, a . _ f f --t . ` ` `4706, :....- Subtotal
n Minimum permit fee. $72.50
Phone: ( 3) 1 -,4, a S Fax: 5 ( 9a - 0 / ( E. Residential backflow minimum permit fee: $36.25 3(p - 15
CCB Lic.. ev y Plumbing Lic. no..
Plan review (25% of permit u y
fee)
b ` ��^ State " u rchar^° (00G of norrnir f 0_ .
Authorized signa 'E� 'c
�r 4��i / . TOTAL PERMIT FEE 1 37 , (S 1
Print name// y) C, r . ! q J DatriQ 0 t This permit application expires if a permit is not obtained .∎ ithin
LLL 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
i:\ Building \Pertnito\PLmF- PerrnitApp -doe 12/03 440-461.6T( I 0/02/COWWEB)
a - 4 89LO ZG9 -EOS U 9 1T 3 ETT =TT SD GO 2nd
'Z CITY OF TIGARD \, .
BUILDING DIVISION PERMIT. #: PLM2005-00372
' 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/16/2666
Phone: (503) 639 -4171 �°8 l
1 Inspection Requests (24 Hrs.): (503) 639 -4175 .J
INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7:06AM PAGE: 68
SITE ADDRESS: 14996 SW HAZELCREST TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 055 TYPE OF USE:
PROJECT NAME: SUMMIT.RIDGE
DESCRIPTION: Installation of backflow device.
OWNER: DON MORISSEI IE HOMES, PHONE #: 503- 387 -7638
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5945
Inspection Request Scheduled For: Date: 8/12/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 013402-01 503-692 -55945 N
Corrections /Comments / Instructions:
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u► • -SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
{/ FAIL (l CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ��, Date: 0 I ' - Phone #: (503) 718-