Permit 1,K
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00445
c ' I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9(8/2005
PARCEL: 2S 109DA - 07300
SITE ADDRESS: 15120 SW HAZELCREST WY ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 050 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
4230 GALEWOOD ST #100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 9/8/2005 $36.25
[TAX] 8% State Surcha 9/8/2005 $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: � J i (� )I Permittee Signature: ey-Tq
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.
Building Fixtures
Plumbing Permit Application i . iv E FOR OFFICE USE ONLY •
City of Tigard u u E `J Received � y 1 { �' l� permit No'7
Plan Rev
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: v I
-y O✓ /�`� 1 i \�10 5< OC 49
iew
Phone: 503.639.4171 Fax: 503.598.1960 SE 0 7 ��ty,/°
.,r, t ; \ DateBy: Other Permit No.:
-. �
24- Hour Inspection Line: 503.639.4175 >' - Date Ready/By: j " r ' s B1 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: /if � Supplemental Information
I ,i i r y ri • • -. •
:.:TYPE: OF .WORK F) E * SCHEDULE
o u" :,u.� -
r1mneir1N
�.:.r.....-
)SkNew construction ❑ Demolition For special information use checklist
.
Description 1 Qty. I Ea. I 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
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
• Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB. SITE INFORMATION AND LOCATION Site utilities
Job site address:/ 51,W „A(,1 C[,Z t;. LG/Z.S.7 a- Catch basin or area drain 16.60
City /State/ZIP: '71 C1G(_4_f•.( Q jr 97 7 7 L, Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project nani-(,(,fry111.Lt� I 9 e., J V Footing drain (no. linear ft.: __) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
-S C-- 6 CGS ae/LaL ao Rain drain connector 16.60
. Sanitary sewer (no. linear ft.: Page 2
��^^�� (. Storm sewer (no. linear ft.: Page 2
Subdivisionid-. Jry1 /ryt. c- /QL_4 .( Lot no, SO Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: () s:S
Absorption valve I 16.60
DESCR ION OF WORK Backflow preventer I Page 2 ,,w2. SS
--Gt- d Se_a fe, / (Y/ qa_ UY1 h f ! y l -<I � 'r!l6", Backwater valve 16.60
C Clothes washer 16.60
Dishwasher 16.60
•
- Drinking fountain 16.60
PROPER . W
TY OWNER. , ...
I . . .0 TENANT
' Ejectors /sump 16.60
Name: 'D C ;^i 111( .. ' i s . f f «C e _s Expansion tank 16.60
Address: /----ti,; 3 U S W C6 - ( C'. -LA) 0 OC. Fixture /sewer cap 16.60
City/State /ZIP /< C. 0 S Lk) <70 ok. / 7 C 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
APPLICANT CONTACT PERSON Hose bib 16.60
• Ice maker 16.60
Business name: L a $ C i. or -c: T'iJ') Interceptor /grease trap 16.60 I
F r
Contact name: 7I ') „Sp arra XJ Medical gas (value: $ ) Page 2
Address: I - a -()O ,c (J) /y) (2../D Primer 16.60
City /State/ZIP:11.J. �/� , o p__ . rj 7(J (a D -- Roof drain (commercial) 16.60
Phone: (563) e' tJc - ,2 -5= I Fax: : (,503) ya - 6 'J ' Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60 •
CONTRACTOR Water closet 16.60
Business name: �AcIse_4� OY7'9O71 2 C.) Water heater 16.60
Address: /' ;-.)-0° S IL) (Y'� / I 1 :Li Other:
Subtotal
City/State/ZIP: �-� s f2 `470(e, �:y
/ r'� I/ Minimum permit fee: $72.50
Phone: 5e.)3) j Q,;1 S 9zig Fax: ( 5O3) (09I - 07 Co g Residential backflow minimum permit fee: $36.25 Sea aS
CCB Lic.: 7 eO Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ,,? . 90
Authorized signs ' .4a4....4..--"1-.0 ' . TOTAL PERMIT FEE 3 9. / s
Print nameg`/ e o? ` Dag.- f -.05 This permit application expires if a permit is not obtained within
�� 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
■stSuilding1PcrmitstPLMF- PermitApp.doc 12/03 440- 4616TM /02/COMAVEB)
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CITY OF TIGARD -
1 BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: PLM2006-00445
Phone: (503) 639 -4171 / e�q'in 1p �� jl, 9/8/2005
Inspection Requests (24 Hrs.): (503) 639 -4175 � _ '
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
114
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 16120 SW HAZELCREST WY LOT #: TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE 050
DESCRIPTION: SUMMIT RIDGE
Backflow preventer for irrigation.
OWNER: PHONE #:
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538
LANL APP- OFEGOR INC. 50"
Inspection Request Scheduled For: Date: Pour Time:
9/30/2006
Code # Inspection Description Confirm # Contact # Message
326 RP /baclflow preventer 0170266 -01 603.692 -5945 N
Corrections /Comments / Instructions:
Ii PASS I I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
I I FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Oo t -- 1 A' Date: q 12 0 J ad'' Phone #: (503) 718-