Permit CI TY OF TIGARD PLUMBING PERMIT
li DEVELOPMENT SERVICES PERMIT #: PLM2005 -00138
X11 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/8/2005
PARCEL: 2S 109DA -05700
SITE ADDRESS: 12797 SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 034 JURISDICTION: TIG
Project Description: 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
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/8/2005 $36.25
[TAX] 8% State Surcha 4/8/2005 $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
PLM ALL PHASE & BA
•
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: i , j . � Permittee Signature: 5' -e Qy
J 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.
1
Building g Fixtures RECEIVED
Plumbing Permit Application APR 0 8 i f 5
Date/By: FOR OFFICE USE ONLY • - • . , p�/
City of Tigard Received
By: V 0 � ' P erm i t Nr f . �/✓ O
G �
13125 SW Hall Blvd., Tigard, OR 97223 /� Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY i ii�+�� OF /4,n ` 'i' 1''``` • L74lcBy: Other Pcrmit No.:
i �; 1;,•'
24- Hour Inspection Line: 503.639.4175 BUILD -tl • ' • . to Ready/By: J° . 0 See Page 2 for
Internet: www.ci.tigard.or.us DV1L " IP I , °titied/Method: -57(r Supplemental Information
TYPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist
Description Qty. [ Ea. I Total
❑ Addition/alteration/replacement ❑ Other: 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
Each additional bath/kitchen 45.00
•
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
•
Job site address: /o')_7 q 7 SO S:LL/n/YLi.� t dy S-I - . Catch basin or area drain 16.60
City/State/ZIP: 72 gt2et D / . y7 a- P- (/ Drywell, leach line, or trench drain 1 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
9z.k) Se t fe,inci (2 Rain drain connector (6.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
/ Water service (no. linear It: ) Page 2
Subdivision: S,,(,•ry‘ rK iT K 1 dq g I Lot no.: 3
Fixture or Item
Tax map /parcel no.: CO SS A 1 7 Absorption valve 16.60
DESCRIPTION OF WORK . Backflow preventer / Page 2 P7.. S
tu•�•,)•d - c!'l,Lfi( it / 7( /t7 U/1 I(Lric {,'uuJ G( Ci_ %t e Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 1 6.60
EL PROPERTY OwNER. Drinking fountain
I ❑TENANT
Ejectors /sterr 16.60 16.60
Name: b C ?'1 Yn r i'l 5 •S C. 1 / 1 C � Expansion tank 16.60
Address: L/, 3 C- S i-i-i GGc. ( etc O OIL Fixture/sewer cap 16.60
City /State/ZIP: C- X L C % .c C.�t e• q6 O/&. • 7 0.3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
APPLICANT : LCONTACT PERSON •
Ice maker 16.60
Business name: I riet s /:CU: -,L 01 -eq0-y Zi^ Interceptor /grease trap 16.60
Contact name: % e, , .. S
e . ....,p { Medical gas (value: $ ) Page 2
F p 16.60
Address: ! 9 - IT, C , /1;'.. u ,2� -
q � C � J . [ 7/ /6 / Roof drain (commercial) 16.60
~7
City/State/ZIP:,I41 t+- t►� , U12_ r , (0
(50.3) ' , !G • /�� C / . r �( f Sink/basin/lavatory 16.60
Phone: (Si
-� r �/S Fax :: / (5 o 3) � �lt � _ �.'
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name:/an p., Z, Water heater 16.60
U -SCI. ... ai�z° / i (- v
Address: / ,.?- -O& S (jJ fp !- i /fir W iz.0 Other
Subtotal
City/State/ZIP: a,QL.." - ? ` ' 47062 �--
I'� Minimum permit fee: 572.50
Phone: ( Q 5 3) ie Fax: C (p�oa e D7 S. Residential backflow minimum permit fee: $36.25 .... ' - zS
CCB Lic.: 7 eV P lumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) a , yC
Authorized signs „ ttg l _,. .X I .p
`/ ,, TOTAL PERMIT FEE 3`7, ($
Print name fie r l() I Date G - a .. 0S 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:l Building \PermitsWPLMF- PemtitApp.dec 12/03 440- 4616T(10✓02/COM/WEB)
2 - d B9LO- 269 -E0S u - BLC :60 SO BO .idd
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00138
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/8/2005
Phone: (503) 639- 4171 °t
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 85
SITE ADDRESS: 12797 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 034 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow device.
OWNER: DON MORISSETTE COMMUNITIES, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5945
Inspection Request Scheduled For: Date: 4/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 004791 -01 503-692 -6945 N
Corrections/Comments/Instructions:
•
•
12 • SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
r FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 d/ _ Phone #: (503) 718 -