Permit 1
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00234
� II. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2005
PARCEL: 2S 109DA -07200
SITE ADDRESS: 15136 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 049 JURISDICTION: TIG
Project Description: Irrigation backflow preventer.
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 COMMUNITES LLC Description Date Amount
4230 GALEWOOD ST #100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 6/2/2005 $36.25
[TAX] 8% State Surcharl 6/2/2005 $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- 699 or 1- 800 - 332 -23 . _
Issued By: Permittee Signature: /7 e / _ _
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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4. Building Fixtures '
Plumbing Permit '111 el i • 1 n FOR OFFICE USE ONLY • •
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City of Tigard q ^ ��9�j / )
DateDate/By: WdC %� 46 Permit No .�D/ / �),1L�[/5 -- 69t/ A't
13125 SW Hall Blvd., Tigard, OR 97223\ 1 Q 2005 t Plan Review r"
Phone: 503.639.4171 Fax: 503.598.196 11GARD t ;� '4t Date/By: Other Permit No/ 5 0 5 -oar 3 .
24- Hour Inspection Line: 503.639.41766? O F wish C`' 1 . Date Ready/By: 0 See Page 2 for
Internet: www.ci.tigard.or.us 911 0 ,t IG p Notified/Method: Supplemental Information
T E OF WORK FEE* SC EDGLE
ti
New construction ❑ Demolition For special information use checklist.
Description 1 Qty. I Ea. I Total
0 Addition/alteration /replacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
•
'1S.,t - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
El Accessory building Cl 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: f 5/,3 SL C) C. Z,' /(_/..5r coa Catch basin or area drain 16.60
City/State /ZIP: 77 q «pL e ' 7 "P-P--41 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: GG Project nalff Yl Lt k, L 4 9 Footing drain (no. linear ft.: ) Page 2
/ Manufactured home utilities 110.00
Cross street/directions to job site:
� Manholes 16.60
S S e e F &- N ` v`// - del) - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision:SC -L/7) TYI. z-F Lot no._/ Water service (no. linear ft.: ) Page 2
� Fixture or item
Ia
Tax map /parcel no.: S
Absorption valve 16.60
DESCRIPT ON OF WORK / f Backfiowpreven[er Paget � T
• �1/ -, .�( ,�. , r /- - / �/ i> 1 bO + '. f f!'";,(,) e7 % /C, , Backwater valve ' 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER , ❑ TENANT Drinking fountain 16.60 •
,_ Ejectors /sump 16.60
Name: ]) ffyi / /lv3 . 7 S •S (-_-__ ,- 1 ' /*Tyy) e. S Expansion tank 16.60
Address: tic). 3c) -s ice) &( ' - ( e.C..c3 0 C )['C_ Fixture /sewer cap 16.60 i
City/State/ZIP:` [ x c X1,5 LL ) c jC Qr�, � f . 7 0.3 S Floor drain/floor sink/hub 16.60
Phone: ( ) / Fax: ( ) Garbage disposal I 16.60
`APPLICANT CONTACT PERSON Hose bib 16.60
/ ^ Ice maker 16.60
Business name: L�f� /! /(S l Cf-/i L O e ?/ y Win. Interceptor /grease trap 16.60
!
Contact name: Eli . /) „... f (ti f -_ Medical gas (value: $ ) Page 2
Address: ! -I) 0 ,,,c-- Li) iii Li (.L al Li g1) Primer 16.60
d Roof drain (commercial) 16.60
City/State/ZIP: ��d2 `;.2_ , c 76'(C -..
t l Fax: c�, c� Sink/basin/lavatory 16.60 i
Phone:
(Sc :3) (c /t --� (..� 3) E 5a - C 1C..:�'
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR • Water closet 16.60
Business name: /_r 6/ C I, =9o7- - _ Water heater 16.60
Address: / -- S ( M, !� -S f �!'.1. Other:
Subtotal
T
Cit ' teteL - - '()(Z - 4706, '.
Minimum permit fee: $72.50 34 !
Phone: Cx e3) &Q{a „S 941, Fax: 6 69a - 0 (, g Residential backflow minimum permit fee: $36:25
CCB Lic.: 7 goy Plumbing Lic. no.: Plan review (25% of permit fee) I
State " "'ltar ^P !40/ of fee)
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b y ...G t .v......
Authorized signal "tCz _ r��� I Ju' TOTAL PERMIT FEE j 31. / S'
Print name d __..,?( T _) Dat0 / / ?S 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.
is \Buitdin PermitApp doc 12/03 440- 4 616T(10 /02/CO
a - d 89L0 Z69 -EOS uaii3 e9S =0T SO z0 ufC
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CITY OF TIGARD .
BUILDING DIVISION - ' PERMIT #: PLM2005-00234
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2/2005
Phone: (503) 639 -4171 :�f
Inspection Requests (24 Hrs.): (503) 639 -4175 -_._...W
INSPECTION WORKSHEET FOR DATE: 6/17/2005 TIME: 7:11AM PAGE: 2
SITE ADDRESS: 15136 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 049 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Irrigation backflow preventer.
OWNER: DON MORISSE.I I E COMMUNITES LLC, • PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
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Inspection Request Scheduled For: Date: 6/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 009603.02 503-692-5945 N
Corrections /Comments/ Instructions: •
r e, c '" — A.-----
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`% ' . SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL , ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: vz /t Date: l.il I 7 6 ) Phone #: (503) 718 -