Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00003
� 111 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/3/2006
PARCEL: 2S 109DA -07400
SITE ADDRESS: 15084 SW HAZELCREST WAY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 051 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 LLC Description Date Amount
4230 GALEWOOD ST STE 100
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 1/3/2006 $2.90
[PLUMB] Permit Fee 1/3/2006 $36.25
Phone : 503 387 - 7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Contact # : PRI 503- 692 -5945
FAX 503- 692 -0768
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 -6 9 or 1- 800 - 332 -2344.
Issued By: ,,4- , Permittee Signature: r fyi ari
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.
PPP P
Building Fixtures F ED
Plumbing Permit App fiCatlon FOR OFFICE USE ONLY
City of Tigard t 'y 20Z� Received
0 Date/By: f " /Q Pemtit No.? ,..0101006,.... 800 03
13125 SW Hall Blvd., Tigard, OR 97223 • Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 C� T1 Y F Or 7 Q 1GF�,,, " �!•'�I . . N 1 Date/By:
iN Other Permit No.:
,A.44-, �
24- Hour Inspection Line: 503.639.4175 I\ • • W Date Ready/By: to Q See Pagel for
Internet: www ct ttg
aCd.OGU 5 u`� .. ® No Supplements
Supplemental Information i
Notified/Method:
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New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
0 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
II bath o ,.,. ..;: CA; T. EG4L2Y:0FY;COhFST ItLtCTIONr' • • ; SFR (1) b 249 20
' hl- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
1=1 Master builder ❑ Other:
Each additional bath/kitchen e) 45.00
2
E dd' ' l b h 45
F sprinkler s ft. Page
r''tr. `;I' ° ST <
`.I O E t
Ot T7,,tP,.9 1'ION . :4., :. • u. , ?'. utilities
. ... :. f:.xt:.trxt; �:,; O.BtI:.: , �M.' m., ,•, •,�.,� : -. .>�.N. .. .,. .... . . .. ..:.. . . ,.
.... , , ..i
, . Site ut Lt s
Job site address: (SO 'L/ S U....) i L 2. -(C ' - (...V I L Catch basin or area drain 16.60
City /State/ZIP: T q Z2�LGL 0/.2. / 7 }-,� i-/ / Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 6 I Projec i EThM (4- / G9e. 5 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 1 10.00
Cross street/directions to job site:
/�
Manholes 16.60
SM.) /3 e _ f 8-erC.L- /2D Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisioni5 77 Lit Lot no.: .S•1 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: (0 S75
Absorption valve 16.60 •
r: DItSCR TION OF;; l!,0 tK : `;,. . :'; ' 'r .i : w reventer P a e 2 SS
e.,.,. al ' Bacleflo p ! g 7
L�r)ii 5e...lac.. rr - ,' q . 0 _ 1 7 �,`Y', b!I..Gk LI 0 c -.1 f1 , Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain
�:; zi . - '•i .i;,i- Jowrt R ;,. . , I '012.'''''' ; ° ,,,; . �I <;, rrAivr:
• , ire::. . .. •�:.; ; :.�, r..�,: , att,,a • .. ' ... • - �' r : - , , - . , .. '''I'''' ...._ - . , ...... >.... Ejectors /sump 16.60
Name: b rh /')')/.;7i) .s .> !`.7 / 61 /' S Expansion tank 16,60
Address: y,.� 3 L' .S LL) L: C< (c:' . CI ci oc L • Fixture /sewer cap 16.60
City/State/Z1P:Lex. / <(_, (% -1 UL; C < %c) L) ..1 L. ; f.� Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
�;'. ` r,. j ,: ,. . Hose bib 16.60
. t : . `.p ``: , "r ':GO CT•-.` ERSOM
: ' • :`.:' - .. , =' ; :; .'< r •..:; ,, . : 1 Ice maker 16.60
Business name: L:t-/ d S /'.L /_!� G �-% / ,-!' ,; :.,„,. Ti,..,: Interceptor /grease trap 16.60
r 1
Contact name: V ; I �1 , j ? r LL;
p w Medical gas (value: S ) Page 2
( �1
Address: j 9' be S LO TY)t.j. I LWI '`
J . D Primer 16.60
JJ , ` •.
CitylState /ZIP: 1n (.l-./ it �" j R G (L s / �(' i , /�' ' � " Roof drain (commercial) 16.60
r C .. .. c J c' - g am. -. ' , J � Sink/basin/lavatory 1 • (S
Phone: c _3) ! /.� - yL, .> : (� 3) & y` -
- - ..l
Tub /shower /shower pan 16.60
E -mail: Urinal 1 6.60
,; . CONIRAC,I'OR; :.: r , ". ` - Water closet 16.60
Business name: LC1. /)d_S(.. Lx.(J (, grr I�, - �f j) ( Water heater 16.60
// Other
J Subtotal
City /State/ZIP: �-�t, ([. ' /
/ ,� � /1 0 Y JC 3 _ Minimum permit fee: $72.50
Phone: 6c3) ( .5 Fax: X 6' -X - 07 Co E* Residential backflow minimum permit fee: S36.25 -3 4, '' S
CO3 Lie.: 7 5 (:)ii Plumbing Lie. no.: Plan review (25% of permit fee)
fl State surcharge (8% of permit fee) o:- 90 i
Authorized signal} '.6 Aea ^u? TOTAL PERMIT FEE 3 9', (.S l i
Print name e .. 4 S ., �? czr , rZ ? -�C,� Da/ This permit application expires if a permit is not obtained ithi
/ 4940 4940 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
is\ Building \Permits\PLMF- PermitApp.doc 12/05 440 -46 t6T/10 /071COM/WEB)
T' 89L0- Z69 -EOS uaTi3 EEO =60 90 co LEC
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CITY OF ��nm m n�pm TIGARD . - ,'
BUILDING DIVISION - PERMIT #: PLKA2006-00003
| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/3/30()6
Phone: (503) 639-4
171
Inspection Reque�u(24Hvaj:(5O3)G39'4175 ,_-_-_61- « IL '
INSPECTION WORKSHEET FOR DATE: 1/10K2006 TIME: 7:00AM PAGE: 54
SITE ADDRESS: 15084 SW HAZELCREST WAY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 051 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Bmukflowpvevwwimr for irrigation.
OWNER: DON MORISSETTE CO%8kNUN|llESLLC. PHONE #: 603'387-7556
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: W3-692-5945
Inspection Request Scheduled For: Date: 1/10/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 021E57-01 603-892-6948 N
Corrections/Comments/Instructions:
�m* / - ��- P'' A.m.- ` ^/ �f �
� �
,
.
p ri PARTIAL APPROVAL �ACANCEL 0 NO ACCESS
; | FA E
�� CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
| | /�
Inspector: r y Date: /L/ F Phone #: (503) 718-
-
.