Permit CITY TIGARD PLUMBING PERMIT
in'I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00469
F�>♦ II DATE ISSUED: 9/19/2005
13125 S Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109 DA -07500
SITE ADDRESS: 15056 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 052 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 [PLUMB] Permit Fee 9/19/2005 $36.25
[TAX] 8% State Surchan 9/19/2005 $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 irect questions to OUNC by
calling 3- 246 -6.• • o - 81 ! - 332 - 2344.
Issu B y: .��,/'� /� _:._ Permittee Signatu -: • ,� , /�•--�
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.
•
•
3/Wilding Filxiu2 rce5
PIaliL+1C11b Perms ut A \ii Oil, t I� 4.• co FOR OFFICE USE ONLY i:3
(City Of Tigard C Received /
13125 SW Hall Blvd Tigard, OR 97, p 1 6 2005 Date/By 7ff / _11 , •d 1PS - 00
Plan Review
Phone: 503.639.4171 Fax: 503.598. At. ; ;,, .. A. Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 J;1 Fr' I i Sans:
Internet: www.ci.tigard.or.us OF TIGARD " " -
�
.ci.tigard.or.us CITY y Date Ready o `21 See Page 2 For
t4V5 MI0N _ I Notified/Mcdtod: 'E* ( � E meotnl Information •
New construction ❑ Demolition For special information use checklist.
Description J Qty. 1 Ea. I Total •
El Addition/alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
CAT_ EGORY OP: CONSTRUC'T'ION SFR (l) bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 11] Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( , sq. ft.) Page 2
•• JOB. SITE tNFOR14ATION AND LOCATION Site utilities
Job site address: ' S-b Ste c5 U) bt CL 2 e ( C re -7 (JQr i Catch basin or area drain 16.60
City/State/ZIP: T 19 A O k q'7 '?-7- L/ Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project nail .i 4 pet ei C� J ,D._ Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
/2L ,ri . �,,
f1 f �,e - III"`-` -C RD - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
12_,61.4 ..e, Water service (no. linear ft.: ) Page 2
Subdivision:S�,y �
yl rLi. Lot no- a off.- Fixture or item
Tax map /parcel no.: Cz SS. /q II
Absorption valve 16.60
•
DESCRIP .ION" OT WORK Bachflow preventer / Page 2 a S S •
a Apr', i rr f &f1 U?'1 hG ( I / /; Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER - Q•:-TENANT-
Ejectors /sump 16.60
Name: n - ' 1 Grc S S c i • -/• /-7 6.5 Expansion tank 16.60
Address: Z--t; 3 c; s (Ai, , C ' -( E . 0 OCL c?-703 Fixture /sewer cap 16.60
City/State /ZIP: G� /KC (? S i(? �57CJ 0 S Floor drain/floor sink/hub 16.60
Phone: ( ) - Fax: ( ) Garbage disposal 16.60
• Hose bib 16.60
a APPLICANT` '� •.CONTACT PERSON` •
• -- '' - - Ice maker 1 6.60
Business name: LLi, a .. (/ _e-,t, OG'
f o Tit'') Interceptor/grease trap 1 6.60
Contact name: -:L/ /ff) •,,.o C -rL(j Medical gas (value: S ) Page 2
- 3 - J(U
i / t 16.60
1�3
Address: � � Sal l �'1 t,} :� Primer
City /State/ZIP: fjL ( /L . 0 2 , J " � Co Roof drain (commercial) 16.60
Phone: (50 3) & e,,. - •S i(./ J Fax: : (,� A 3) f t o - C/ '7 „i'
Sink/basin/lavatory 16.60
Tub /shower /shower pan • 16.60
E -mail:
• Urinal 16.60
• CONTRACTOR. - Water closet 16.60
Business name: 4d -5ce 07' - r9UYI G Water heater . 16.60
Address: / ' - S a) in lifS- ial,Li ,2,p Other:
City/State/ZIP: i7 9"d Paz 7 06" ; Subtotal
Minimum permit fee: $72.50
Phone: 5C) 48 Q 'e•,�4ys Fax: 6y03) 69 m 0? f, g` Residential backflow minimum permit fee: $36.25 3 (p • Q-S
CCB Lie.: 7 if-by Plumbing Lic. no.: Plan review (25% of permit fee)
O State surcharge (8% of permit fee) el- , 90 • Authorized signs"_ `r� ,,aA� T OTAL PERMIT FE>
Print name T// e v i u ; �r6, v . Lrz,ti�) Daq /(o - 0 S This permit application expires if a permit is not obtained "itltin
/ 180 days after it has been accepted as complete.
• ''Fee methodology set by Tri -County Building Industry Service Board.
i:\ nuilding 'J'erndts1PLNF- PermitApp.doc 12/05 440 -461 GT(INO /C'OMJWEu)
T' 89L0 -z69 -COS uait3 eDO :II SO 91 daS
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CITY OF TIG
BUILDING DIVISION PERMIT #:
PLM2005-00469
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
9/19/2005
Phone: (503) 639-4171 im
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
9/22/2005 7:12AM
SITE ADDRESS: CLASS OF WORK:
15056 SW HAZELCREST WY
SUBDIVISION: LOT #: TYPE OF USE:
SUMMIT RIDGE 052
PROJECT NAME:
SUMMIT RIDGE
DESCRIPTION:
Backflovv preventer for irrigation.
OWNER: PHONE #:
DON MORISSETTE COMMUNITIES LLC, 503-387-7538
CONTRACTOR: PHONE #:
LANDSCAPE OREGON, INC. 503-692-5945
Inspection Request Scheduled For: - Date: Pour Time:
..: 9122/2005
Code # Inspection Description . Confirm # Contact # Message
399 Plumbing final 016389-02 503-692-5945 N
Corrections/Comments/Instructions:
1 .--e----A. — al/L.— ..1 \? 1
,
9 ,
vir Li PARTIAL APPROVAL El CANCEL ' El NO ACCESS
0 FAIL fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: V&IC.—__.—.- Date: 6/ 7 2- Fhone #: (503) 718-