Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00139
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/11 /2005
PARCEL: 2S109DA - 08600
SITE ADDRESS: 12970 SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 080 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 COMMUNITES LLC
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/11/2005 $36.25
[TAX] 8% State Surcha 4/11/2005 $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
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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: ` " Permittee Signature: _IA e sZl 0
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.
w .�,� RECEIVED
Budding Fixtures AA 1
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Plumbing Permit ApplicationAPR !'V 2115 FOR OFFICE USE ONLY • •
City of Ti and CIT OF T , . / Date/By: `7 // 1) ) � ' 0 � � A . F ,
`J g P erm i t N
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 BUILDING "t,7 o / � � ` ' " 1 Dates Permit Other Pert No.:
24- Hour Ins e ction Line: 503.639.4175 11 :f� ' ' y
p �� ° � �.. Date Ready/By: lure: Q See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: ..7 Supplemental Information
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TYPE OF WORK . FEE* SCIIF.DULE
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For special information use checklist
hNew construction El Demolition
Description 1 Qty. I 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
Accessory building SFR (3) bath 399.00
❑ ry g ❑ Multi -family
❑ Master builder Each additional bath/Idtchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE 'INFORMATION AND .LOCATION Site utilities
Job site address: /2J? '7C) i.nt ot, let el 5 J � f �-- .� Catch basin or area drain 16.60
City /State/ZIP: 7j•)� Q 4 9 7 a..) / t. F / Drywall, leach line, or trench drain I6.60
Suite/bldgJapt no.: [Project name: : /71 Nl i -e Q pc Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
Q ,, ,p r✓ Manholes 16.60
IA) EQ� 8.e. 1.L ( /€ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: __) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision cernm 11 �( e t ae / I Lo t no.: --6�
Tax map /parcel no.: Co 6- A 7 Z Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2 .7 • SS'
La-44 • (2.. ape, i rr / q o--rt7 07) h (,l.G/f / ! y� Ul () 61,,, / 1 .,„+- Backwater valve 16.60
. Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
a. PROPERTY. OWNER. .. I . • • CI TENANT
Ejectors/sump 16.60
Name: b C - Y , 490y/ S S t° f # /7i0-yo eJ Expansion tank 16.60
Address: 1 f r a 3 0 S U_I &,,-,f d 4..-4..:1 OCC Fixture/sewer cap 16.60
City/State/ZIP:L.Cs e Q � LO <70 Q/2- y 70.3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
. .APPLICANT CONTACT PERSON
Hose bib 16.60
Ice maker 16.60
Business name: lc� ;r C� S ,� 0 ,,„_:_. O / ,
� 9�`� T� Interceptor /grease trap 16.60
Contact name: I f) . f ) G.T 7 Medical gas (value: $ ) Page 2
Address: i 9 -C) D ,.c. o fyl L S - ,ip t L iz.D Primer 16.60
City /State/ZIP: - [ M Uk_. . -1 7G,(0 Roof drain (commercial) 16.60
Phone: (50 .3) I /G• e/, - 9 /S Fax: : (-53) 6, ycR - C' /7&,,,C' Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
• CONTRACTOR • Water closet 16.60
Business name:,�4_Se,• _90-7) .,./-) G Water heater 16.60
Address: / aa-GG S r j) ityl Li S-/✓ i Li R.../.0 - Other:
City/State/ZIP: t(,j�,f•7� 44 `r 6
6- 47Oe.,-- Subtotal
"�f
Minimum permit fee: $72.50
Phone: c (0Qa 5 WS' Fax: 6 (p9(;? - 070 g Residential bacicflow minimum permit fee: $36.25 310 • '-S
CCB Lic.: 7 eU Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) era . C f 0
Authorized signs ,E „iJ� 1
® TOTAL PERMIT FEE - 3 - 1. (.S
Print name1/ ,c/' � Dar, Li -g This permit application expires if a permit is not obtained ..•ithin
18D days after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pennits\Pt.MF•PermitApp.doe 12/03 440-4616T(10/02/COM/WEa)
2' d 139L0- 269 -EOS uei13 E'IE :LO SO ii add
CITY OF TIGARD
BUILDING DIVISION
�~ / PERMIT #: PLM2005.00139
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/11/2005
Phone: (503) 639 -4171 / a ,n.d 'ill
Inspection Requests (24 Hrs.): (503) 639 -4175 ` - _—
INSPECTION WORKSHEET FOR DATE: 4/21/2005 TIME: 7:08AM PAGE: 1
SITE ADDRESS: 12970 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 080 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow device.
OWNER: DON MORISSLI It COMMUNITES LLC, PHONE #: 503- 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.692 -5945
Inspection Request Scheduled For: Date: 4/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 005075.01 503 - 692 -5945 N
Cor rr 1
Corrections/Comments/ Instructions:
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L ASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Ins ecto Date: < Phone #: (503) 718 -
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