Permit fCI
CITY OF TIGARD PLUMBING PERMIT
Aro DEVELOPMENT SERVICES PERMIT #: PLM2005 -00374
II ` DATE ISSUED: 8/10/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -12200
SITE ADDRESS: 12998 SW KOSTEL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 111 JURISDICTION: URB
Project Description: Installation of backflow device.
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. STE. 100 Description Date Amount •
LAKE OSWEGO, OR 97035 [UPLUMB] Permit Fee 8/10/2005 $36.25
[UTAX] 8% State Sure 8/10/2005 $2.90
Phone : 50.3- 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: Permittee Signature: _S/ .e, (1
•
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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•
- Building Fixtures .
Plumbing Permit Application N lJ FOR OFFICE USE ONLY
City of Tigard Received _ / �j.�
�100� 1 DateBy: I [/) -- Perrnit N IV 07i7e /W
/l 6 2 '7t/
13125 SW Hall Blvd., Tigard, OR 97223 Q Plan Review t
Phone: 503.639.4171 Fax: 503.598.1960 �q
�y ' h l�l '1" / 1 -
, _ Date/By: Other Permit No.:
24 - Hour Inspection Line: 503.639.4175 Z 1,1 Date Ready /By: f°tis BJ See Page 2 for
Internet: www.ci.tigard.or.u5 Notified/Method: '� Supplemental Information
TYPE OF . WORI i G U FEE* SCHEDULE
el`A1 construction V3 V For special information t.
❑ Demolition ormation use checklist
P .f
Description I Qty. I Ea. I Total
❑ Addition/atteration/replacement El Other: New I- 2- family dwellings (includes 100 ft, for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
-'1.- and 2- family dwelling ❑ CorttmerciaUindustrial SFR (2) bath 350.00
1:3 Accessory building ❑ Multi- family SFR (3) bath 399.00
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❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION _ Site utilities
Job site address: /a le .. L
k -.1" t1 Catch basin or area drain 16.60
City/State /ZIP: T"lp e f 6,,f2._ 9 as y Drywell, leach line, or trench drain 16.60
Footing in
Suite/bldg. /apt.no.: I Project gt r /l `ri g drain ( no. linear ft.: ) Page
Cross street/directions to job site:
"` Manufactured home utilities 1 10.00
„ e � /� / Manholes 16.60
S 4 , 0 13.I /' L ? ( e C> 4 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2 •
Subdivisiot tni (1Jytq- /2L l Lot no: /// Water service (no. linear ft.: ) Page 2
/ Fixture or item
Tax map /parcel no.: LO s A' Absorption valve 1 6.60
• DESCRIPT ON OF WORK
Bacl(flow preventer Page 2 07 SS
,- )t! • -S L'. ape, , rr, q at; (c,-, bC1. G 7�% 4 ,,./�; / (� Backwater valve 16.60
/ / Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
: PROPERTY, OWNER. El TENANT
Ejectors/sump 16.60
Name: be' J"! )CY, S S t f * / 1 e: S Expansion tank 16.60
- Address: 1-f a. 3 0 S l Est ( .)o oet Fixture/sewer cap 1 6.60
City/State /ZIP:[,L-2_kC O S irk e -/ 0 CP_ 73:_3 S Floor drain/floorsink/hub 16.60
Phone: ( ) / Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
‘'&I,APPLXCANT , CONTACF PERSON
Ice maker 16.60
Business name:
r• /. l
c / <.L/ Tom') C
( ..f Interceptor /grease trap 16.60
Contact name: ' / �'
�ol:� ��
Address: 0 LG'.,s' ✓{' - L�i' Medical gas (value: $ ) Page 2
t
.SL) _c-U.) � i rlti:� Primer 16.60
City/State/ZIP: ()t (i_f C.; �� 70(c cL. Roof drain (commercial) 16.60
Phone: (56 (G• q•- - J- 9 I Fax:: (503) f!'61 - G 7 -',.-.c" SinkJbasin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 1 6.60
' CONTRACTOR Water closet 16.60
Business name:! _o_)as' i• i ,e_ -7- � - fin J G Water heater 16 -60 J
Address: /' ---GQ . /L) _�(1 LJ Ss 0 l. a pp ,� Other:
City/State /ZIP: d -?� ` � 04. '47U Subtotal
`1,([,�
Minimum permit fee: $72.50 �� �
Phone: (`jc3) l ,S Fax: 5 ( 9€ [0
- '76" , " Residential backflow minimum permit fee: $36.25
C,CB Lic.: 7 G Pl umbing Lic. no.: Plan review (25% of permit fee)
O U � _
- - - - - - -- - -- - - - nal �_ - 106 , 6 L'�� State c trcl z- e (gq� or �, ;r fee) a - - --
Authorized sig
TOTAL PERMIT FEE [3, . i.S
. I Print name-:// en S f7 ° l')��,, Date/ q/ 61 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.
is\ Building\Pcrmiis\PLMF- Permit App. doc 12/03 440- 4616T( IO /02JCOM/WEB) -
a' d B9LO- ZG9 -EOS uaii3 BEE =TT SO' 60 2nd
CITY OF TIGARD
BUILDING DIVISION , PERMIT #: PLM2005-00374
13125 SW Hall Blvd., Tigard, OR 97223 A 0 DATE ISSUED: an 0/1006
Phone: (503) 639-4171 I notfAi#
Inspection Requests (24 Hrs.): (503) 639-4175 AW 'EL.
INSPECTION WORKSHEET FOR DATE: 8/22/2005 TIME: 7:10AM PAGE: 89
SITE ADDRESS: 12998 SW KOSTEL LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 1 ii TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Installation of backflovv device.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503_3874638
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 8/2212005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 . - Plumbing final 013960-02 503-692-5945 `1
,. . .
CorrectionsYCOmments/Instructions:
1 '
Tuici-- 44-----
1
AritiodialfP" . ..
, .
i ,....epsss 1 1 PARTIAL APPROVAL E] CANCEL NO ACCESS
0 FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
-AC q 1 r
Inspector: ------ Date: Phone #: (503) 718-