Permit CITY TIGARD PLUMBING PERMIT
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DEVELOPMENT SERVICES PERMIT #: PLM2006 -00063
DATE ISSUED: 2/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA - 12100
SITE ADDRESS: 12982 SW KOSTEL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 110 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 2/3/2006 $36.25
[TAX] 8% State Surcha 2/3/2006 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
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 -6699 or 1- 800 - 332 -2344.
Issued By: , Permittee Signature:
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 _
i grolEIV Piumbing Permit A 1 , :4 FOR OFFICE. USE ONLY
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13125 SW Hall Blvd., Ti City of Tigard A a� . P c mritNo �/�
®3 200 DateBy:�� J \ • / U�
Tigard, OR 97223
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Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /r,;tf. +� l c�� Other Permit No.:
+ �f�i�',' �� Date/Sy:
24- Hour Inspection Line: 503.639.4175 , _,�„l�l� •I 1± Date Ready/By: ,iri ®See Page 2 fur
Internet: www cs tigard.or.us c r Notified/ Method: Supplemeotat Information
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1 •
101 New construction ❑ Demolition For special information use checklist.
Descri . don • . Ea. Total
II Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
�7p1%� �� - y� , u Ear, r,;pi• r :• �
R.'wx:..rY. 4 f xi :'t,' 4t I c y'x /,01!3 it r � :off`, t SFR (1) bath 249.20
�'eP ..ir °� ° ?. .�..�'..Fla.:_- a.' '! > �:rs, L.. i�Si.' i;3:.�.<.rra dOeiFvg�� n. '� •'', �i
❑ 1- and 2- family dwelling ❑ Commercial/industrial SW (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
* lzrx ,a y rt rr° Y�°1' c" 4{ sTR, Fire sprinkler( sq. ft.) Page 2
'� ,! a. ' } ` IA'Ai- >,a . l FYI ., . t !{� i•irr ) y ,<,. .p
S.� 'i.. - �+. �. 3, kums .. �i�3. iYL'ti. iri= "++�"Y +Z„ 'df1����7� - '` �lu'li:, Site utilities
Job site address: 1.41 i.Z S t.) /.</C- LQl2L- Catch basin or area drain 16.60
City/State/ZIP: (ga4c ? op_ 9 l ? a- if , Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project namurn,n e t /mac �. qc'/ Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
6 C. L /- ie --iat. R 4 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
SubdivisionSi l,/ymi_ (. 1 e , � 6 I L n o.: 1 to
Fixture or item
Tax map /parcel no.: CD �,S-." /4 16.60
`+F4,.p�•• iice�,,,, r'.`"+ •'t '•;�• a�w�'^!,' a , y; ,.,.�µ:. �f,.'. :.4 •'Y1>: -., :: �.,x ti , > i {- . �� h �i�!
Absorption valve
F4)�� . ` ��.r.;:?w� sy,;,,::;." r w;;. Backflow reverter Page ,9.7 .SS
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LC/ . SL (,t�/ / rr / q 0 u?-) -i h� �
?Ala() ul (.) ��/ / (` Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 16.60
,,ryry-- �+ r r , Drinking fountain 16.60
�„ �, 'T7' -R� , {�'�'��J� ����- r' L�j t �tr P �l' r I fi7fi�t��r ' i� ,. y P>
2ir,.r_�..h._, - __h.- �.l±r._.�2:.F ��k. s;r �••..A .' Ejectors/sump 16.60
Name: b rY' in [}yj s s _-f- 4. / Vy) t' Expansion tank 16.60
Address: L-f vZ 3 Q S LU 6 <<f e -e-t) 0 0/3L Fixture /sewer cap 16.60
City/State/ZIP: L-Cc -/k c 0 K LC) ?C) 0Q. � 'f 7 ()3 S Floor drain/floor sink/hub 16.60
/
Phone: ( ) Fax ( ) Garbage disposal 16.60
s , E .1 . % a u a". r, e a Hose bib 16.60
.........__ �.� '"Q'- ice maker 16.60
Business name: !
L� /�C/ (> �/'� �Jp' T I n t ercep t or /grease trap
16.60
E-7/ P i
Contact name: 7! v/v „Sp cLrr . Medical gas (value: 5 ) Page 2
Primer 16.60
Address: 1 � 'a-QU .� -{,�} 11114S-/��� 6 _
City/State/ZIP: ( J U (L . 70 o Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503) (O 4. - . SIcl S I Fax:: (52 6 YL.,q - G' 2 &cc."
Tub /shower /shower pan 16.60
E - mail: Urinal 16.60
r N ^t ' r � ^` �. ' /e_iF ,� � �i': 1.. .
it !� ivi}ri 'rt }" w 4 E . ^� F ... Gf a , T ii : i �. ; u .� ir'1:'' W ater closet 1 6 . 60
j al�i om y Fif +�rt' -� . •:5 t. 1 ...ir a.r . . :�5!: irt; .,:iy ;.lie,•, t ,
Ili sines name :'' llk __ //IISen -t,0. Oyt 9 7-) 7::_r? c„,, Water heater 16.60
P. ddr.iss: f �-0O Other: i _
a /,�' _� Subtotal D-7 • � s
City/State/ZIP: 71 CQ C� t 7I'1 UQ 7O ec Z- Minimum permit fee: 572.50
Phone: 503) tpQa Tf 9 Fax: (503) (e• c;.? - Q 7( 0 g Residential backflow minimum permit fee: 536.25 -3 ('.- Q
CCB Lic.: 7 gU Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) _ i0 _
Authorized signa TOTAL PERMIT FEE ' m 39 -
/ S
f l
Print name `/ / S 7 ?� r_c) Dat.'9/. ' (- This permit application expires if a permit is not obtained within
"� �f ` 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building \Permiia\PLMF- PcrmitApp.doc 12!03 440- 4616T(10/02/COM/WEE)
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CITY OF TIGARD
BUILDING DIVISION
PERMIT #: PLM2006-00063
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 202006
• Phone: (503) 639-4171 ' avAiligli.11-
Inspection Requests (24 Hrs.): (503) 639-4175 ,4j- .1_!.... •
INSPECTION WORKSHEET FOR DATE: 2/(/20(J3 TIME: 7:02AM .-• PAGE: 3
SITE ADDRESS: 12132 SW KosTEL, LW CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 110 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Backflow preeenter for irrigation.
OWNER: DON IviORISSEITE COMMUNITIES IIC, PHONE #: 60.367-M36.
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503
Inspection Request Scheduled For: Date: 202006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
. 399 Plumbing final 026339-01 6n692-6946 N
Corrections/Comments/Instructions:
. r GE .
7 PASS I I PARTIAL APPROVAL fl CANCEL 0 NO_ACCESS _
0 FAIL 0 CALL FOR INSPECTION . fl ADDIT L ONA FEES ASSESSED
D a t e: / h <OW .-2.5
Inspector: (6 .
Phone #: (503) 718- t4