Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00620
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/2/2005
PARCEL: 2S109DA-07600
SITE ADDRESS: 15032 SW HAZELCREST TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 053 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 #100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 11/2/2005 $36.25
[TAX] 8% State Surcharq 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 -80 33 -2344.
Issued By: AA?) Permittee Signature: a 1� ,` @AT/
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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C ;. ) . 21 1 DateBy: \ � � � Permit No.. '
13125 SW Hall Blvd., 'Tigard, OR 97223 NOV 1
Phone: 503.639.4171 Fax: 503.598. I960 Plan Review
r L • ),:„;t t Date./By: Other Permit No.:
24 Hour Inspection Line: 503.639.4175 CITY or TI �:�'
Internet: v/Ww.ci.ti ard.or.us } = •i ' - .,\ Date Ready/By: J 5 D Sc e Page 2 for g BUILDING Notified/Method: l � f Supplement :t Inrnrm:
1 - \ TIl'E 0 WORN l 1 E* SC :HIEEM :LE
New construction ❑ Demolition For special information use checklist.
Description l Qty. l Ea. I Total
❑ Addition/alteration/replacement ❑Other: New I - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF d 0ISSTRUCSIO'I SFR (I) bath 249.20
1- and 2- family dwelling ❑ Commercial /industrial � SFR (2) bath 330,00
El Accessory building El Multi-family SFR (3) bath 399.00 '
Each additional bath kitchen 45.00
El Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
_ __-_- _ Site utilities
Job site address: I S� .54-A..54-A..) }
IS r ("u � f Catch basin or area drain 16.60
City/State/ZIP: - • , c k_ U 9 D � Dryweil, leach brie, or trench drain , 16.60
-
Suite/bldg. /apt. no.: Project name L h � /y� .C.:',3 Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: // Manufactured home utilities I IO.DD
•
Manholes ' 16.60
u,, ge-e-- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
•
Subdivisions U-rt ∎ rn, b;- dg e_.; Lot no.: S3 Water service (no. linear ft.: ) I Page 2
Tax map /parcel no.: Fixture or item
-- Absorption valve I 16.60
DESC.RIPTI'.7N OF WORK 1
Backfl preventer Page 2 v SS
,_•:- , / d M1- Backwater valve 16.60
Clothes washer 16.60
Dishwasher - 16.60
F PRO PI R I Y OSVNJGIt. Drinking fountain 16.60
[( T1;I�AN
' - Ejectors /sump 16.60
Name: b 6 Yii ,'Kf %)-- '/ S S t='. ')'- r /7CY!') t'_ J
Address: , � � r „,� Expansion tank 16.60
2 -f 3 C S F 6' l ( C .t 0 (Ace . Fixture/sewer cap 16.60
City /State/ZIP:L s...,, c 0_(,' C i0j C) k_ -17(i- S Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
AI'P I,ICAPlT Hose bib
.: CON A CT PERSON 16.60
�_ /�. /' y , r,t� 7-1 Ice maker 16.60
Business name:
J' t 4 r Tom^
Contact name: ,, %),' ?r -
V Interceptor /grease trap 16.60
' G I Medical gas (value: $ ) Page 2
Audtess: rJ -_; • -ij) f v 1,i,: --'i i nt.'' ;Z.[) Primer 16.60
City /State /ZIP: s /' J Roof drain commercial
>✓ / 1:`L , ✓ rL. / 7C' �' o� (commercial) 16.60
Phone: (,50:3) /•�tv) --_j fU j Fax: : („5 �' cr�� - C.' 7!,---',-;-' Sink/basin/lavatory • 16.60
E -mail Tub /shower /shower pan 1660
Urinal 16.60
CONTRACTOR
Water closet 16.60
Business name: / 1 t '_S eiy..J.2o J . ` . Oti ,,�, ( Wate heater
�U7 . �f,• 16 60
Address: 1'� -�-G✓ ( ?% .��r�f, }pi fP.;� Other:
City/State/ZIP: �,r' '— dpi. pp. 47Q( __ -.._ Subtotal 1
I Minimum permit fee: $72.50
Phone: C,';:4- & l .1 �-6 T/ l (:)'72 r
Fax �- �) .��� -> E. Residential backflow minimum permit 3
it fee• $36.25 60 ' ..2.S
CCB Lie.: `% n'`.)j-f Plumbing Lie. no.: . Plan review (25% of permit fee)
, y a t State surcharge (8% of permit fee) . 6 /0
Authorized signaW z - -± ,..y .r /i --. e :
`-- --- u r t. �'--''t L- +'� " i '• / TOTAL PERMIT FEE 3q • is
Print name! =`j / +1 .'� ;
( ---) � /;: C /_;' ".. I Da `t�' -- �-v s I This permit application expires if a permit is not obtained chin
J 180 days after it has been accepted as complete.
*Fee methodology set by Tri-Counry Building Industry Service Board
i.\ Building \Pcn:uts \PLMF- PermiiApp.doc an 440 - 16 1 o•r( loicoicoyi,wEB)
Z'd B9LD- X69 -EOS u eS0 =6D SO ZD 'OW
CITY OF TIGARD
BUILDING DIVISION _ PERMIT #: PLM2005.00620
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2/2005
Phone: (503) 639 -4171 ' 'lI t
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 11/3/2006 TIME: 7:06AM PAGE: 34
SITE ADDRESS: 15032 SW HAZELCREST TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 053 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflowt preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503-387-7539
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5946
Inspection Request Scheduled For: Date: 11/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 020236 -02 603-692 -695 N
Corrections /Comments / Instructions:
•
I
E 'ASS n PART £ L APPROVA ! °ICEL P NO ACCESS
I FAIL • 'A FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector. • %A■ Date: 7 " ° 3 Phone #: (503) 718-
/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S -00620
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/2/2005
Phone: (503) 639 -4171 .. u '' 'a4�urmii d( It\
Inspection Requests (24 Hrs.): (503) 639 -4175 �.....�i -'I ..
INSPECTION WORKSHEET FOR DATE: 11/3/2005 TIME: 7:06AM PAGE: 35
SITE ADDRESS: 15032 SW HAZELCREST TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 053 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Rackflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.692 -5945
Inspection Request Scheduled For: Date: 11/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 020236 -01 603-692-6945 N
Corrections /Comments/ Instructions:
6 ' ASS IN PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL IN 'LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
f r S Ins ector: .4 Date: C Phone #: (503) 718 -