Permit x
c CITY OF TIGARD PLUMBING PERMIT
I :: DEVELOPMENT SERVICES PERMIT #: PLM2006 -00130
' 1 11 13125 SW Hall B Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/12/2006
PARCEL: 2S 109 DA -12300
SITE ADDRESS: 12995 SW KOSTEL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 112 JURISDICTION: TIG
Project Description: Backflow prevention device 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 4/12/2006 $36.25
[TAX] 8% State Surcharl 4/12/2006 $2.90
Phone : 503 387 - 7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Contact # : PRI 503- 692 -5945
FAX 503- 692 -0768
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 5 - 6699 or - 800 - 332 -2344.
Issued By: ., J6.� Permittee Signature: _e__ lam- L--
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building F ixt u res �{hfj -'b0�7 0
l.�
Plumbing P2rmit Applimatiin FOR OFFICE USE ONLY
City of Tigard rtnQc Rived
l/ Permit No. 13125 SW Hall Blvd., Tigard, OR 97223 vs
Phone: 503.639.4171 Fax: 503.598.1960 < ;mr ;,;;� I +` �\ DateBy: Other Permit No.:
24 Hour Inspection Line: 503.639.4175 APR I- l U P 6.111 J 5 : •
Internet: www.ci.tigard.or.us
,,,,4!„00,- ..+ Note e d /d t , 1 Information
g y y El See Page 2 for
, Notified/M thud 'G Supplement
i
; TYPE',.!�l�t,�Y►fvtstc�✓ :: �'�.� : .', -!• . . . . . E*' '$CFIEDiJ L$' j
ul - (� "c 1 N,/ I NT N. For special information use checklist.
O or s ec �, New cottsttuction � J �4 ]�e�rno l{tton t • ' - . p
Description 1 Qty. 1 Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
6 . 4 77 C SFR (1) bath I 249.20
X - and 2- family dwelling ❑ Commercial/industrial ' SFR (2) bath 1 350.00
SFR (3) ath 399.00
❑ Accessory building ❑ Multi - family )
❑Master builder ❑Other: Each additional bath/kitchen 45.00
? - , ., . ire sprinkler e ( , sq. ft.) Page 2
F' 1 I r P
,,. JOB., 5 E T h Y F'ORMATI O]�I : -:.A ND LO , .. .. .
- .. �.. .� .- . .. ,,. Site utilities
lob site address: / 9 C S StJ K041 to C 6t2-/1{, Catch basin or area drain 16.60
City /State /ZIP: n 1. c; � fl 9 7 L -L/ - Drywell, leach line, or trench drain 16.60
Suite bldg. /apt. no.: I Project namCyuyy i Vii. Footing drain (no. linear ft.. ) Page 2
�� ,� D_..... Manufactured home utilities 1 10.00 .
Cross street/directions to job site:
/ Manholes 16.60
6 e-e._ - '.y%i -- ) Rain drain connector 16 60
Sanitary sewer (no. linear ft.: ) Page 2
_
Storm sewer (no. linear ft.: ) i Page 2
Subdivision:S. ( rA Lt � ��j ".� j Lot no.: I ` 2
Water service (no. linear ft.: ) Page 2
7 Fixture or item
Tax map /parcel no.: 1 0 - l9 Absorption valve 16 66
• • ESCRIIY.TIQN::OF WQ�tTC :,y ''' • .. . ,.. .. . . ; , Backflow preventer / Page 2 ;. ) , SS
I h./;Gi (:•`_ ( 1 - f,`/% r r , // 0.17 ,..,,,-/-. b. %i (..,..i."" 7r _' / %%: i v _ Backwater valve • 16.60
Of Clothes washer 1 1 6.60
Dishwasher 16.60
'P Drinking fountain 1 1 6.60
ROPERTYYf.O' I:itR. ` S TENAN . ' ,
,,.... : •, '.'..: ;,:. a :' ; `'' ' ..., E -
ectors /sump 16.60
Name: I) e y fr`)/ i s . S !'. • `� ( LI_ 11_,t. 4f7 '.S L. expansion tank 16.60
Address: '-i,1 j Li S f,t_+ L4,-.,. ( I t i LI ,e ( Fixture/sewer cap 16.60
Ci _
/ State/ZIP: !',_ / ` Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16,60
:APP7 CCdNTACT „ PRSO, l ore t o
• bb 0
• Ice maker 16 60
Business name: !1z /; /1 :/'j / r. !:6' !'./_j(;Y\ y:/'; /"• Interceptor /grease trap 1 i 16.60 I '
Contact name: '
�., ; ,•_:,/) .... ' % ✓ % �Li Medical gas (value: $ ) Page 2 1
Address: Primer 16.60
City/State /ZIP:'- U (,L (� �" Gl �- 7 /� c- - 7/ ' l Roof drain (commercial) 16.60
1 F � � . .
Phone: (54.';•3) Cc / :• . -� ,' L.J j Fax: : (5,2, E.• Y - 1 , ' . i,
Sink/basin /lavatory 16.60
Tub /shower /shower pan j 16.60
E -mail:
Urinal 16.60
> ir;�C
... • .,. , • O'VTAACTORi' Water closet 16.6G
Business name: t-t if L St v' p C . 9,, Water heater 1 6.60
Address: , .... -•&(. S 0) /yn, l y. / U
Other: •
City/State/ZIP: '�t L -711 'O 'fit O ;,1. -. Subtotal
Minimum permit fee: $72.50 '`
Phone: 6j(..3) &4 ,S -'WS Fax: �C3) 6,9Q - [7 r ] (c7 g Residential backflow minimum permit fee: $36.25 3 .o, 0L
CCB Lie.: 7 g'(..) Plumbing Lic. no.: i Plan review (25% of permit fee)
State surcharge (8% of permit fee) I . 90 ,
Authorized sign 7
� e71 C � TOTAL PERMIT FEE 13 ?, i 5
Print nameg• j/ en ,- ;?CL,r�7 t& Dat L1 Oj(
- f1 - G ' This permit application expires if a permit is not obtained %•• i thin
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board,
i\ Building \PcmtitsV'LMF- PeemitApp.doc 12/03 440 4616T( I 0 /O2JCOMJWE9)
2' d B9L0- 269 -EOS ua1 e-170 :0i 90 TT add
CITY OF TIGARD • . -
BUILDING DIVISION PERMIT #: PLM2005-00130
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4112/2006
Phone: (503) 639-4171 Abh
Inspection Requests (24 Hrs.): (503) 639-4175 •
INSPECTION WORKSHEET FOR DATE: 4/25/2006 TIME: 7;00AM PAGE: 83
SITE ADDRESS: 12995 SW KOSTELLN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 112 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: riackflovii prevention device for inigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503-387-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 603
Inspection Request Scheduled For: Date: 4/25/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 0285901 503-692-5945
Corrections/Comments/Instructions:
X --PASS fl PARTIAL APPROVAL CANCEL NO ACCESS
I FAIL fl CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: /14 k Date: kt/Z ti Phone #: (503) 718- °{-31