Permit 4 C ITY OF TIGARD PLUMBING PERMIT
I 4, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00216
,.�� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: PARCEL: 2S 10 2510 005
9DA -05600
SITE ADDRESS: 12785 SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 033 JURISDICTION: TIG
Project Description: Irrigantion backflow.
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
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 5/27/2005 $36.25
[TAX] 8% State Surcharq 5/27/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
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 503-246-6 or 1- 800 - 332 -2344.
Issued By: 4' Permittee Signature: lam')
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. 1/
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.
-7. p'uilding Fixtures
AI f umbiug Permit A •> t IVES FOR OFFICE USE ONLY
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City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 p n Datt•1By: '/ ,.7 ! Permit No.: 2' b
Phone: 503.639.4171 Fa c: 503.598.1960' �/" O 2005 Plan Review a �
/'"7 `r', NSA Date/B Other Permit No.:
24 Hour Inspection Line: 503.639.4175 CITY OF T{GA' ' / I� Y•
�'� �. Date Read
Internet: www.ci.tigard.or.us �p t A �y Ready/Ely: lure
.- Ju�La�latc No ed/Method: T /�! EA See Page 2 for
Supplemental Information
TYPE p1F.:WOR.K FEE* . SCHEDULE
'I N
New construction ❑ Demolition
Description For special information use checklist checklist
❑ Addition/alteration/replacement ❑ Other: QTy• Total
New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF ;CONSTRUCTION SFR (1) bath
249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi-family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION AND LOCATION Fire sprinkler ( sq. ft) Page 2
Site utilities
Job site address: I �7 es - ce.A. , eLQ G 02 Catch basin or area drain
16.60
City /State/ZIP: 7 - G e G ) g 7 7 ,)-y Drywcll, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: l I Project name L yuyi t flai I!Cf e_ 33 Footing drain (no. linear ft.: _ ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
/�
Manholes 16.60
E� b c ef- d en U Q/L Rain drain connector
16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: S (fin l yt (✓ j- k L ei q e. I Lot no.: 3 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: ( S S /I ! J Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
y � / Backflow preventer / Page 2 .2_7 S
7 S
1.- 1.4 y14 °S %' az6 If Qa-h [m p flax) Giet)/e 1 Backwater valve 16.60
L
Clothes washer 16.60 •
Dishwasher 16.60
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'. la, PROPERTY OWNER... . I ❑ • TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Dam f 170 SS e- 71.1' Hcayy) C S Expansion tank
16.60
Address: L-1 30 S ui G( o Get_ Fixturelsewer cap 16.60
City/State/ZIP:LoLkc 0ELk) L96 0 .. ' 733 5 Floor drain/floor sink/hub 16.60
Phone: (• ) Fax: ( ) Garbage disposal 16.60
APPLICANT CONTACT PERSON Hose bib 1 6.60
Ice maker 16.60
Business name: 1�pla S C J , •6 Oi ( 7 �� c � �`� r{J ^ ' i ..Z i G Interceptor /grease trap 16.60
Contact name: �
p Medical gas (value: $ ) • Page 2
Address: / -D-DD .-W nAy f / fw ' 024) Printer 16.60
Cit /State/ZIP : -a Q-h, o , -, q 70 (0 Roof drain (commercial) 16.60
Phone: (50,x) tpr/a -S7C/5 Fax: : (5;a3) , ?a - 0 7� .k Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan 16.60
Urinal 16.60
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CONTRACTOR Water closet
16.60
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Business nam , ( �t,,,
e:1 ^ ( 2- / �� , � Water heater 16.60
Address: /? -a-OO S.0) imu st'. ` U - Z/+, j/�24 Other: -.
City/State/ZIP: ,A 0,2,. 706, Subtotal
Phone: !' /� Minimum permit fee: $72.50
!3) IpQQ $' � Fax: (SO3) 6 9 1 Q ° 07 t,'o g' Residential bacicflow minimum permit fee: $36.25 .3 • tIS
CCB Lic.: 7 e-U Plumbing Lic. no.: Plan review (25% of permit fee)
Authonzed sign t �rt Lgit �,Q�' State currharge (g% of permit fee) o 39, . X j
I Print name h `' - ° TOTAL PERMIT FEE 5
I I Da , clo S I This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i slBuildingWemwsU'LMF•PermitApp. dnc 12/03 440.4616T(10m2/COM/WeB)
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I'd -- - 89L0- 269 -EDS uat doi :20 SO S2 ReW
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S-00216
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/27/2005
Phone: (503) 639 -4171 � �'° A i1
Inspection Requests (24 Hrs.): (503) 639 -4175 ":_—
INSPECTION WORKSHEET FOR DATE: 6/6/2005 TIME: 7:13AM PAGE: 69
SITE ADDRESS: 12785 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 033 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Irrigantion backflow.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503-387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
Inspection Request Scheduled For: Date: 6/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 008495.01 503 -692 -5945 N
p I -A. �S r..;--Q Corrections /Comments/ Instructions:
olisiS(4)::;:ipiy i
,z / e10 11//iir
/ °.I°".°'
ryl PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: C// #: (503) 718-