Permit CITY TIGARD PLUMBING PERMIT
A" DEVELOPMENT SERVICES PERMIT #: PLM2006 -00002
- - 1 1� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/3/2006
PARCEL: 2S109DA -12600
SITE ADDRESS: 12931 SW KOSTEL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 115 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 Description Date Amount
4230 SW GALEWOOD ST. STE 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 1/3/2006 $36.25
[TAX] 8% State Surcharl 1/3/2006 $2.90
Phone : 503 387 - 7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
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 -6.99 or 1- 800 - 332 -2344.
Issued By: 11/ Permittee Signature: p a l ,1ilLi] t
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
CEN
Plumbing Permit AppliOtrii_ FOR OFFICE USE ONLY . . ..
el nac Received
Tiard, OR 97223 0.. AMIIIII:=N... 4 ' 0 --A9g,•_:
City of Tigard , %IA ?), LuA Date/By:
13125-SW Hall Blvd., g Plan Revie Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 Atzpiiii„,,ei41,4I\ Date/By:
24- Hour Inspection Line: 503.6394175 1 :_
cs v./ o „_,.._ -__.. Date Ready/By: J is' • np 2 li fo n r form.tio ,,
Internet: www.ci.tigard.or.us 111 1 ' - Notified/Method:
lt 51 g9V;' ; - ;.;..; W '' . . ) :,: , ; .. :r , ;'::; . :zill':- ., -',::•':il::':- . .';%; ,. . 1 :': 1,,, :: P'' S - - ''''' ' .: • • •
For special information use checklist,
Nci New construction P Demolition
Description [ Qty. i Ea. I Total
El Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
.. cIirgaiiii .':.'`.... ,: :.:,.:.' ' ,, - SFR (l)bath 249.20
and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
0 Accessory building P Multi-family
Each additional bath/kitchen 45.00
El Master builder 0 Other:
Fire sprinkler (_____ sq. ft.) Page 2 .._
'1:-.• :'Segi;;i4kiiiiiAiikiii4k '' -: • :4 Site utilities
Job site address: i ae?„3 / .S.4_,0 / ' e2A e.....) Catch basin or area drain 16.60
City/State/ZTP: T I a.- O" 97 .,,k Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: Project nangtLry)/Y1c.t a_9 e_,)
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
•
_f.() 8 e__ c- F ig.,2-1t ct- R...0 . Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ____) Page 2
Subdivisio4y14s111.1.1 /2- V e.) 1 Lot no.: I/ s Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.: ta S S 1 ' 7 . , . Absorption valve 16.60
'''•:.,:; ' :` Si.•11241)*Iiii : I! I' '''•:J: i ... : , : .
Backflow pr „ en („ / Page 2 c ;2 7, SE
16.60
L a..64 Se:. aer, i r r , c a:/ (i ft\ 1 -, 0,, ,....; , .# rti... ,.. ,... 4 ... Backwater valve
Clothes washer 16.60
Dishwasher 16.60
• :- ..., - • • ?:. Drinking fountain 16.60
s• ,, ;-`•'! ` 44:'-:Uiiii'bi i &i:i. 4 014k .. . 4j : ,' • 1 : 11 4t .. .' -,!. '..i;4•: .. .4::•:••: • tAf::..:.-: .'• . 16.60
Name: b 0, (Y)(_71 _c .•s "=- -* /-7` e. _s Expansion tank 16.60
Address: 3 c... ..S Lt..). C.... t e e e: 0 ec-(.., Fixture/sewer cap 16.60
--, , , _, c - Floor drain/floor sinIc/hub 16.60
City/State/ZIP: L__c.t. /< c, L .,, L t ) e . / .6 Q .._. (:-/ ' 7( L,_-_, .7.)
Garbage disposal 16.60
Phone: ( ) Fax: ( )
••• • ... r;-i :. •• ,:.,. Hose bib 16.60
. ;• • 4 : - ::•.?•;.1:,::::.. : : . ;:;.&N:- . &:i7 H k0 - ;,0,40t4, • ...
16.60
Business name: t_zi- r, a e. 1 if .c.'.. (),--e' (/, ,.i <i- Interceptor/grease trap 16.60
/
Contact name: 1-- ! :::-:/) -.Sr (-Li' •i% .!".-10 Medical gas (value: S _ ) Page 2
Address: I D c) 0 (
( rr) I an./ OD Primer 16.60
Roof drain (commercial) 16.60
City/State/ZIP: ai)- , (L., (2__ , --' / 7 L Ce ;_)---
Sink/basin/lavatory 16.60
Phone: (56'3) Ce; e/.. - -G- (.-./ 5 Fax: : (57:' 3) &.- 5/ .-;1 - (--• 2‘.--:'
Tub/shower/shower pan 16.60
E-mail: ,
;':"' dOSI , '''':'. "•! •:::!'f•1'.(- !. :'''."'. ,• ..• , ': '•'•:'' ':', ":. ;.:' *. Water closet 16.60 ..
. .
Business
Water heater 16.60
name: toii ciSe 4 ,, ) c . 0?-7. 4 . / 0-7-; ,t.._,--) c
, Other.
Addis: / ...--,.)--CiC) „S (Lj M 9 .51 yi. ___ - -
Cit 7U. a,I d 2 no (, •-_,,__ subtom;
Minimum permit fee: 572.50
Phone: 61.3) &Q, _S-9...,ir Fax '0 -3) &9c7? - 37 Co Es Residential backflow minimum permit fee: 536.25 a0 -
Plan review (25% of permit fee)
CCB Lie.: 7 goy Plumbing Lie. no.:
n State surcharee (8% of permit fee) 1 .,.2 . C)
Authorized sign,ge'te..Z./1 Va,A.,..2_4//7_,6") 1 TOTAL PERMIT FEE 1 . / S'
Print name'// eil „c Dat 13 i 0( This permit application expires if a permit is not obtained ,, ithin
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
i:\BuildingTerrnas\PLMF-PermitApri.doe 12/03 440
E d 99L0-a69-ED S _
u ii3 eila:B0 90 ED uer
CITY OF TIGARD •
, BUILDING DIVISION PERMIT #: PLM2006-00002
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/30006
Phone: (503) 639L4171
Inspection Requests (24 Hrs.): (503) 639-4175
:
INSPECTION WORKSHEET FOR ,..._.i v itiP
DATE: 2/6/200 t 1 TIME: 7:02AM PAGE: 7
SITE ADDRESS: 12931 SW KOSTEL LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #.115 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Baci4lovv preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES, PHONE #: 503-3077536
CONTRACTOR: LANDSCAPE OREGON, Ilx!C. PHONE #: 503-692,5945
, .
Inspection Request Scheduled For: Date: 2/612006 . Pour Time:
Code # Inspection Description Confirrript Contact # Message
399 Plumbing final 026336-01 503692-5945 N
Corrections/Comments/Instructions:
/ --------- 77
- '
PASS 7 PARTIAL APPROVAL El CANCEL 1 NO ACCESS
n FAIL IR CALL FOR INSPECTION 11 ADDITI NAL EES ASSESSED
ON
6
Inspector: Ailtif ' Date: z Phone #: (503) 718-
IIIP"