Permit „.
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CITY TIGARD PLUMBING PERMIT
�► PERMIT #: PLM2005 -00430
DEVELOPMENT SERVICES DATE ISSUED: 9/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -04000
SITE ADDRESS: 12892 SW PINE VIEW ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 017 JURISDICTION: TIG
Project Description: 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 9/6/2005 $36.25
[TAX] 8% State Surcha 9/6/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone : 503- 692 -5945
Reg #: LIC 7804
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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: , f1 Permittee Signature: .-�c .
B
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.
• 1 " .
4 Building Fixtures
Plumbin Permit At ll tio ED FOR OFFICE USE ONLY •
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R eceived _ _
City Of Tigard 7 -) rp Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 . 0 6 q [ Review
e 111 atly3 4
Phone: 503.639.4171 Fax. 503.598.1 V 1J LOOJ Na�awh, ( Plan Date/Ely:
Permit No.:
24- Hour Inspection Line: 503.639.4175 ■ •' Date Ready/13y: Iuru ivi ®
See Page 2 for
Internet: www.ci.tigard.or.us
CITY OF TIrAFiD N 1 Supplemental Information
• ..T jgJktI1MRA9ISION . FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement [7 Other: New 1-2-family dwellings (includes 100 ft: for each utility connection)
• CATEGORY OF CONSTRUCTION ' SFR (1) bath 249.20
- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JO SITE INFORMATION AND .LOCATION,
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• • • • •• • .:-
• • Site utUitles
Job site address: I ` ea _ 9 &. S in Pi ne V/ eLij Ste- Catch basin or area drain 16.60 I
City/State/ZIP: 7 Yt e 4. L. C)le q 7 t3 DI--/ Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no.: 6 Project nams 7 yyl,' lieLett7L, Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
c U) 2 e _ e � 6 66 ^' n Manholes 16.60
J K RD Rain drain connector 16.60
Sanitary sewer (no. linear ft.: r ) Page 2
Storm sewer (no. linear ft.: . ) Page 2
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Subdivisiot ,Uy) rn Lt- ki_a q U I Lot no.:L ( Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: to s5- /4 Fixture or item
/ Absorption valve 16.60
DESCRIPifON OF WORK . . • • Backflow preventer Page 2
L1 e�i
C1,/)d SC�i 1rr/ /(/, J ( /'j7 /j�j.C,p/C 11 au) Gi'F , /es;;, Backwater valve p 16.60 • SS
66 l Clothes washer 16.60
Dishwasher 16.60 • PROPERTY. WNER. Drinking fountain 16.60
• ISI P .O .... • : I' . , ; (] : z J -ENANT :. .
Ejectors/sump 16.60
Name: b tm PY) CYi s s e _,4 # H I e S Expansion tank 16.60
Address: Z--t.,1 3 C, S (L &z".4 ..e t L O 0 OCL .. Fixture/sewer cap 16.60
City/State/ZIP:LG,. e_, Q S r:_f.) C /.0 OQ, cJ . 703 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 • APPLICANT ' CUNTAC'T PERSON Hose bib 16.60
• ' '" Ice maker 16.60 •
Business name: L s 1 .C', 0o'egQyl J�
f ��(( Interceptor /grease trap 16.60
Contact name: l �✓) ...Sr &fro - 4J Medical gas (value: $ ) Page 2
Address: / � . -)Q "C rn 11S-army 120 Primer 16.60
City / State/ZIP: D--- Roof drain (commercial) 16.60
Phone: (5'03) (G• 9,a -S% /S I Fax: : (5's) & PLR - o i l(• Si Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR.. Water closet 16.60
Business name: te .� � �� C, Water heater 16.60
Address: / -00 . Lt? m y 671 Other:
City/ State/Z1P: rl J ae. '4 7U r (O � - Subtotal
Minimum permit fee: $72.50
Phone: (54:3) 44 Fax: (sO3) (,9o? - d r](p Q' Resi dential backflow minimum permit fee: $36.25 .3(p- _S
CCB Lie.: 7 tU I y� ( l Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized Sig13 State surcharge (8% of permit fee) 02. 963
TOTAL PERMIT FEE 1 3y, ( S
Print name8W e LB? U I Dale_ �_ Q S� This permit application expires if a permit is not obtained within
i' 180 days after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
i:, BuildingtPennirslPLMF- PernitApp.doc '12/03 440 4616T(10/02/COM/WPB) •
2 - d 891.0- 269 -EOS uai i3 eib0 =B0 SO S2 °and
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 00430
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/6/2005
Phone: (503) 639. �� �
Inspection Requests (24 Hrs.): (503) 639 -4175 "'f I ..
INSPECTION WORKSHEET FOR DATE: 9/72,2005 TIME: 7:1�AM PAGE: 6
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SITE ADDRESS: 12892 SW PINE VIEW ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 017 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE # : 503-387-7538
CONTRACTOR: PHONE #:
LANDSCAPE OREGON, INC. 503- 692 -5945
Inspection Request Scheduled For: Date: 9!22/2005 Pour Time:
Code # Inspection Description /5 Confirm # Contact # Message
399 Plumbing final 016385-02 503-692-5945 N
Corrections /Comments/ Instructions: .
T � - S - r k 1. Z 7 — SC2::::triS
o rV
V r - pAss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' "T `- Date: / Phone #: (503) 718-