Permit 6 f -
CITY OF TIGARD PLUMBING PERMIT
i� DEVELOPMENT SERVICES PLUMBING
PLM2005 -00311
'�'I� 13125 S W Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: PARCEL: 2510 005
2S 109DA -08700
SITE ADDRESS: 12950 SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 081 JURISDICTION: URB
Project Description: Install residential backflow prevention 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 LLC Description Date Amount
4230 GALEWOOD ST # 100
LAKE OSWEGO, OR 97035 [UPLUMB] Permit Fee 7/14/2005 $36.25
[UTAX] 8% State Surchi 7/14/2005 $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
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
952-0001-0011 • • ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 50 -246-6699 • r : 0 r 332 -2344.
Issue' By: �` / 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.
C.Wilding !Fixtures
Plumbing .Pcrrffu t / ' 1�.PS._tio .. FOR OFFICE_ USE ONLY
R � �� t.... Received Permit N o.. 'LH -60
'
13125 of Tigard 9 ►LLL��� Date/By: 7 3 O � .�_io `"'���r i
13125 SW I loll f31vtL, 'Tigard, OR ')7227 Plan Review Other Permit No.: •
Phone: 503 639.4171 Fax: 503.598.1900 , - " .v.,t,illi Date/By: •
�
24- Hour Inspection Line: `!)3.639.417 -' 5. 1� - C: Date Ready/By: a 21 See Page 2 for
Internet: w•ww.ci.ttgard.or us - : - r -t - _ i4ocL6ed/Method: Supplemental information
f�Y� +4�� 4flth� j,�ci
l -and 2- family dwelling t -
❑ Demoliti For special information use checklist.
New• construction _ Description Qty. I Ea. I Total
I
❑ Addition /alteratiOn/replaccnrent ❑ Other: New I- 2- family dwellings (includes 100 Cl. for each utility connection)
CATECORY OF CONSTRUCTION CONSTRUCTION CTLON SFR (1) bath 249.20
� { 'D Commercial/industrial SFR (2) bath 3 50.00
SFR (3) bath 399.00
❑ Accessory building I ❑ 'Multi-family
❑Other: 45.00
Each additional bath/lcitchen
❑ Master builder Fire sprinkler ( f.) Page 2
JOB SITE 'NEORv1ATION AND LOCATION Site utilities
Job site a d d r e s s : / ( l _.l-LI S i.LMM.( ±' late y C.• DR__ Catch basin or area drain 16.60
City/State/ZIP: ` a. ((t u r p 7� Drywell, leach line, or trench drain 16.60
C Footing drain (no. linear ft.: _ )
Manufactured 2
Suitc/bldg. %apt. no.: Project C rojcct narttc:,si1 /)) t t R(LI e� p 110.00
anufacturcd home utilities
Cross sireel/directions to job site: Manholes 16.60
,'u) 1-ta {2D 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
Subdivisions L.LJTWv •
C-I k L c(S e.. Lot no.: p / Fixture or item
(+ S
Tax map /parcel no.: (• S 1'T J Absorption valve 16.60
DESCRIPTION OF WORK . Backflow preventer / Page 2 .. "2 , �S,
(: � •__ ;'t , -7 / , G, le..(ye : f l UL :.1 t;, Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• - Drinking fountain 16.60
❑. PROPERTY OWNER ❑ TENANT 16.60
• Ejectors /sump
Name: , ,,. ' '- I "' ;' ; 1•7 .' _S Expansion tank 16.60
< _
Address: L . _ , .. f (' is :' L'i (ti (c Fixture/sewer cap 16.60
( ' C. ;„ S Floor drain /floor sink/hub 16.60
City/State.ZlP:(,. c'. ;,' �'. (: , 1_ ; , t • % C': r% 7 b.
Garbage disposal 16.60
Phone: ( ) _ Fax: ( ) G Hose bib 16.60
❑ .
' PPI,ICANT `QCONTACT PERSON 16.60
- . _ Ice maker •
Business name: L(?, , :e j •- 1.;.% •. , _ : " "e"(f r; / .. r-r Interceptor /grease trap 16.60
_ ! '
Contact name: ' L. Medical gas (value: $ ) Page 2
�r � Primer 16.60
Address: :f (.‘ .. , ,. , r (; ; i`• t.; .,1 %i
Roof drain (commercial) i 6.60
Ci /State./ZIP :•' r; .,. J i' '7/' ,�
ty i . .i _ Sink/basin / lavatory 16.60
Phone: c7.;,:.' �) =/ - -- -' ' ,;-; ,: i I Fax :: (,' ,,c'.7) I- y::1 - L A' S" Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
- - - - CON'1'12,'.CTOR Water closet 16.60 {
Business name:. (.r 27:./? C. Water heater 16.60
r , .,� ,.., n '.�
Other:
Address: (: , i�,r Subtotal
City /State/ZIP: J .. a . /ti ,>r , " j'.' % '4'7/ ')& a'• Minimum permit fee: $72.50
Phone: l��::'s) ,�:f. %., �
3 .- .*.:..:::- Fax: Cn� �" 07 67g
Residential backflow minimum permit fee: $36.25 .F&.. '>J- C
= , Plan review (25% of permit fee)
Plumbing Lic. no.: ^
CCB Li :;L� =_f g State - b a ($1./ fpe frrl .a. el0
• � .. ate SIl. C..�. ^ �..,c O. r _.. -...
Authorized signor rr' [ .i::.' -G` !`�. '
I TOTAL PERM1'f FEE /', LS
Print name r' ;:'1 % : 1 Da ' I This permit application expires if a permit is not obtained :thin
� ._� ' ", /`.., ?- '., %- 1 �f �` J G~ e 180 days after it has been accepted ns complete.
'Fee methodology set by Tri -County Building Industry Service Board
i7 \800,11n -01' nniuU•INIP 'tcru,iinl:p doe 12:03 440- 4616T(I0 /02iCOM/w1; a)
2• d B9L0- 269 -E0S uait3 eib2 =GO SO ET inc
Sep.20. 2005 11:03AM • CLEAN WATER SERVICES 503 6814439 No.9232 P. 7
Permit #: 05 - 002783 - 00 - PE
C1eanWater(Services
Our r.nmmitmrul iy nspection Request Line: 503 -681 -4444
2550 SW Hillsboro Highway 4 hour notice required for all inspections
Ilillsboru, OR 97123
Ph: (503) (,81 -3600
Project Name: SUMMIT RIDGE, LOT 81
Project Address: 12950 SW SUMMIT RIDGE ST Issued By: Nichole Vanderianden
Type: Sani/SWM Connection Issued: Jun 29, 2005
Single Family Expires: Dec 26, 2005
Project Description: THIS IS ONE OF 7 LOTS THAT TIGARD MISTAKENLY ISSUED PERMITS FOR. THIS PERMIT
IS BEING SET UP WITHOUT FEES, TIGARD HAS ALREADY COLLECTED FEES AND THEY
SENT THE CHECK COVERING WHAT WE WOULD HAVE CHARGED TO SUE REYNOLDS,
Owner Applicant Contractor
VENTURE PROPERTIES, INC. VF tiIURE PROPERTIES, INC NONE
4230 GALEWOOD ST, STE 100 4230 GAl.KWOOI) ST, STE 100 •
LAKE OSWHUO OR 97035 LAKE OSWEGO OR 97035
Number of Equivalent Fixture Units (FU) 16 Number of Sy FI 2640
Treatment Plant Durham • Water District 'Tigard
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TOTAL
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I HEREBY CERTIFY THAT TIIE ABOVE INFORMATION IS CORRECT.
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SIGNATURE: Date: •
VENTURE PROPERTIES, INC
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00311
13125 SW Hall Blvd Tigard OR 97223 D ATE ISSUED: 7/14/X)05
Phone: (503) 639 -4171 A � 1�'I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/25/2005 TIME: 7 :12AM PAGE: 57
SITE ADDRESS: 12950 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 081 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Install residential backflow prevention device.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503.,387 - 7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5945
Inspection Request Scheduled For: Date: 7/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 012040 -02 503.692 -5945 N
Corrections /Comments /Instructions:
—4t — 1 -- -Q s k - 1,3ILk s c...s2,5
0 64 i l l ii f i l'ilf..P.)ISLI ‘
in - , SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
(IC ��0 r
Inspector: (/ L Date: ..." Phone #: (503) 718-