Permit CITY TIGARD PLUMBING PERMIT
044 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00675
DATE ISSUED: 12/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 109 DA -12500
SITE ADDRESS: 12969 SW KOSTEL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 114 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 12/7/2005 $36.25
[TAX] 8% State Surcha 12/7/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
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.
i•11l h!lg 1xitanres
,
(City of Tigard " 9• Received I Pemut `lo. 7 -
13125 SW Hall Blvd., Tigard, OR 9,72nLL3� DateBy:a -7 6�'7 "F�W j - 6 15
Phone: 503.639.4171 Fax: 503.598.1960 flan Review
t"1 2005 _ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639,417 EC 0 \J d 444,11k
Internet: vivo Date Ready /By: ) / �I El See Page 2 for
r NotifiediMethod: f I \ 111 Supplemental tnfurmatiun
ry,,,,s ce; v.qo ti\RD
,�IZ 1 U :■b:J,' SCfiF_'Di;l_F,
h construction BUILD ?,, ti tL���
IN Ll 19.1 tnon For special information use checklist.
Description j Qty. j Ea. I Total
❑ Addition/alteration/replacement I ❑ Other: I New 1 -2- family dwellings (includes 100 ft. for each utility connection'
CATEGORY 01? CON STRUCI'ION SFR I (1) bath 249.20 i
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
El Master builder - Each additional bath/kitchen 45.00
11) Other: _
- - Fire sprinkler ( sq. ft.) Page 2
JOB: SITE INFORMATION. ;1ND • LOCATION
G�r/-p /' _- _.. - - -_- Site utilities
'7
Job site address: `a LL` COS kL 1 16.60
L eL!'1 '� Catch basin or area drain I
City /State /ZTP: 7 - f G �1C{ 0 9 7 ?-a. / Drywell, leach line, or trench drain 16,60
Suite/bldg. /apt. no.: C J Pro j ecl S CI 15EVY)M.4.4.ir 4_41 etc /1 Lf Footing dram (no. linear ft.: ) P age 2
Cross street/directions to job site: / / j Manufactured home utilities 1 10.00 {. -
.5;?A C'•„ /1� / Manholes 1 16.60
8 f / �-e -1 ∎- �� Rain drain connector ' 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision �ryym le C . Lot no.: //1--/ Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
(.0 �: 4 7 --
Absorption valve 16.60
. • D1SCRiP r.1ON OF WORK _
t Back low preventer j Page 2 ,a7 , SS
if-�''E' n , i•
' ..)!` ,,,_,./),(,... - f ;J /26 - -/ 0 - ; „. 1 //,.) 0 i 7 _ 1 C;t _; / C Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60 • • n PROPhR lC ®�t!IVzi - - Drinking fountain 16.60
. In • TENAI\ T
Ejectors /sump 16.60
Name: e. i'1 rn o ;/1 s S i,- - / e j
Expansion tank 16.60
Address: y;a 3 G. S 1..,1_3 ��, e . 0 `i 0 Cicc, Fixture/sewercap 16.60
City/State /ZIP: :_it `^; . (1_,t,, 7 -, c) (..:)/2..... �% '7 lJ -$ s Floor drain/floor sinkc/hub 16.60
Phone: ( ) / I Fax: ( ) Garbage disposal 16.60 '
''APPi ICAN7• -_...J ',CONTACT PElft SON - {lose bib 16.60
Ice maker 16.60
Business name: if L_ /. /I.'✓.; 7-....--,,,-,.,......, �•
Interceptor/grease �� '' tor/ ease tra
P �' I 16.60
Contact name: �_, i , 1 .n ( , ,y i_ Medical gas (value: $ ) Page 2
1.
Address: t L) 0 S . .!C-) ,t""Lk L ; , L t '2,D Primer 16.60
City /State/ZIP:- L• /t ' /I , _' ' ' , � commercial
30 � : L� 7� ' /
V r ' � - Roof drain (commercial) 16.60
Phone: (54 ) (L: './....-..7 - J lt_ /� Fax:: (t;e �) G, ,`t.;1 - C. /1�,,.�'• Sink./basin/lavatory 16.60
E -mail:
Tub /shower /shower pan 16.60
- - - - Urinal 16.60
CONTRACTOR . •
Water closet 16.60
Business name: Lai d S � i z tom , 07-e.9.0 Water heater
� ��) G I 16.60
Address: / 0-00 S /(') /v1 : c..-(t�� L/ � Other:
/ZIP: 7 -e. ii r Subtotal
City/State/ZIP: are. 0» � . 7"...;y Phone: v� /` �' a' r Minimum permit fee: $72.50
C54.. ) ;q Q,- ,' F ax: C5 ) 0
�� � t 9 ,.�� Residential backflow minimum permit fee: $36.25 34 4 �S
CCB Lie.: 7.T.il -; I Plumbing Lie_ no.: Plan review (25% of permit fee)
Authorized si n t -
r 1- - State sur (it% of nar IP.P.) I ...2. , 9'0
�n
N G - %� �iG" �, feu e;.?�
J ____,,,4./: f. _ TOTAL PERMIT FEE 3y , / •5
Print name �PJ
/,/ : K) , S,-p.- e/ ^� c,..' 1..1.„....) J Dat 0 7 /6S This permit application expires if a permit is not obtained ithin
180 days after it has been accepted as complete.
*Fde methodology set by Tri -County Building Industry Service Board.
c lBnilding1Permas\PLMF- PerrnitApp doe 12/03 4.0- 461e:'t m /02/COM/weut • �'d 89LO Z69 -EOS u a11 3 e0i, =60 SO LO oall
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLIvi2006-0067
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1217/200s
Phone: (503) 639-4171 /AA
Inspection Requests (24 Hrs.): (503) 639-4175 ■
INSPECTION WORKSHEET FOR DATE: 2/6/2006 TIME: 7:02m PAGE:
SITE ADDRESS: 9969 SW KOSTEL LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 114 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSEUE COlviMUI4ITIES, LLC, PHONE #: 603.387_1538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 5t3..59275945
Inspection Request Scheduled For: Date: 2/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 026290-01 603
Corrections/Comments/Instructions:
;IC
•
I ASS _ I PARTIAL APPROVAL CANCEL_ EI NO ACCESS
I I FAIL IIII CALL FOR INSPECTION fl ADDITIO AL F ES ASSESSED
Asa_ Inspector: Date: 6 Phone #: (503) 718-214q--,