Permit w CITY OF TIGARD PLUMBING PERMIT
�� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00133
'l 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/5/2005
PARCEL: 2S 109DA -08500
SITE ADDRESS: 12992 SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 079 JURISDICTION: TIG
Project Description: Installation of 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 MORRISSETTE COMMUNITIES Description Date Amount
4230 GALEWOOD ST # 100
PORTLAND, OR 97035 [PLUMB] Permit Fee 4/5/2005 $36.25
[TAX] 8% State Surcharl 4/5/2005 $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
PLM ALL PHASE & BAC
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 • : •99 0 1- 800 - 332 -2344.
Issued B : A A `< Permittee Signatur
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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Eketildtng Fixtures r,
Plumbing Permit ApREC V ED FOR OFFICE USE ONLY
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City of Tigard R °CO1° ate/B 4 r� O S rp /
13125 SW Hall Blvd., Tigard, OR 97223 APR 0 4 2005 �'� Permit N o.: '�aOD 3 3
Plan Review
Phone: 503.639.4171 Fax: 503.598.194Q /;- , I r Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 IT OF TIGA ' L Date Ready/By: /a 12l See Page 2 for
Internet: www.ci BUILDING DIVISION Notified/Method: ia Supplemental Information
TYPE OF •WORK FEE* SCHEDULE
0 New construction ❑ Demolition For Special information use checklist.
Description 1 Qty. 1 Ea. 1 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
❑ • ccessory building ID 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:`29! c ��.l m/Y) it /' n Jaye, s Catch basin or area drain 16.60
City/ State/ZIP: 7 Cj aft Q i e y 7a3 y Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no.: / I Project name: -sum Lk' feidf P. 79 Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
r �C� � Manholes 16.60
O W ,6 e e. 62- r ,, 41 � Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _, Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision:S:1 M Lt. R I Lot no.: 77 water service (no. linear fl.: ) Page 2
Lo
f Fixture or Item
Tax map/parcel no.: • l!/ /7 Absorption valve 16.60
.2. .7 . -s - . 5 -
DESCRIPTION OF WORK
Backflow preventer / Page 2S
Lail[ d -S' ape ! rr/ Q (. (.T4 hCu': 7 4 70)- (. ae...S / e k , Backwater valve 16.60
j Clothes washer 16.60
Dishwasher 16.60
1E+. PROPERTY. OWNER.. _ . I • CI TENANT • Drinking fountain 16.60
Ejectors/sump 16.60
Name: b pin Kr)t-tr( S s e 7 t. t / i t) t_s Expansion tank 16.60
Address: Z-10_3 G S Lai &,,-, ( e Z. U (le
L. Fixture/sewer cap 16.60
City/State/ZIP: C, L; S �t ' t' ) L g_, y '7 0.3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
APPLICANT CONTACT PERSON • Hose bib 16.60
•
Business name: Ice maker 16.60
LLt./ , cf f er 6 0 ,. e - y, TZ-) ..
<
1 / Interceptor /grease trap 16.60
Contact name: Elf ,J�7 . fKO Page Medical gas (value: $ ) Pa e 2
Address: / - P-1)0 ,W0 rn v S,! n 20 Primer 16.60
City/State/ZIP: - ii44-70'l o2. , 7 ' Roof drain (commercial) 16.60
Phone: (56/ 3) (G C/ -- -59c/ S I Fax: : („5 ,/c Y't - C-' '7�.t�' Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR • Water closet 16.60
Business name:��� - 23-ian Co Water heater 16.60 .-
Address: / a. ?-00 S /0 NI NI LJ , - 11.04 -1 /Z-10 Other:
City/State/ZIP: / U r24 - 7v� y J oR_ D- Subtotal
`- Minimum permit fee: t
Phone:
(5(J3) ✓ Q Fax: (5 03) (p 9c - 0 7 (a g' Residential backflow minimum permit fe • $36.25 0 to - otS
CCB Lic.: 7 e(� y Plumbing Lic. no.: Plan review (25% of permit fee)
�' ,a "`� (�
� '1 `` State surcharge (8% of permit fee) c/ Q
_
Authorized si TOTAL PERMIT FEE 39, i S
I Print name - 7 / .'�es'a'U Dat.L j -4 - C}S This permit application expires if a permit is not obtained "
%' 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00133
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/5/2005
Phone: (503) 639 -4171 �
Inspection Requests (24 Hrs.): (503) 639 -4175 M
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 84
SITE ADDRESS: 12992 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 079 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow prevention device for irrigation.
OWNER: DON MORRISSETTE 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 004794 -01 503. 692 -6495 N
Corrections /Comments /Instructions:
g _PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t 14 Date: � Phone #: (503) 718-