Permit C ITY OF TIGARD PLUMBING PERMIT
i� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00528
,. I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/7/2005
PARCEL: 2S 109DA -04300
SITE ADDRESS: 12790 SW WILLOW POINT LN ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 020 JURISDICTION: TIG
Project Description: Backflow preventer 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 MORISSETTE COMMUNITIES LLC
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 10/7/2005 $36.25
[TAX] 8% State Surcha 10/7/2005 $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
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: S,_e Q V
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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Building Fixtures
Plumbing Permit AppliAtn FOR OFFICE USE ONLY
GEN Received
City of Tigard / Permit N .
13125 SW Hall Blvd., Tigard, OR 97223 � y'V � ' *�"'0� Od
OCT lar Review
Phone: 503.639.4171 Fax: 503.598.1960 ls a O 20 /c a: _r, Other Permit No.•
24- Hour Inspection Line: 503.639.4175 4 J,l `�: � it Dak�y'
Internet: www.ci.tigard.or.us -. Date e d/ See Page 2 for
• TICARO Notified/Method:
o: et Supplemental taformadoa
TYPE 011' t, n)S FEE* SCHEDULE
New construction BU ' ❑Demolition For special ch
al information rue ecklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 I
pl I- and 2- family dwelling ❑ Commercial industrial SFR (2) bath 350.00
❑A ccessory building ❑ Multi -family SFR (3) bath 399.00
❑ Master builder Each additional bath/Idtchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE IN FORMATION AND LOCATION Site utilities
Job site address: P SW `Lid ihruJ Po f . L Catch basin or area drain 16.60
City/State/ZIP: ri ( � 1( ,L _ 0 9 7 a-,3L/ Drywell, leach line, or trench drain 16.60
Suite/bldg./apt no.: t I Project na i t a l G p_� Footing drain (no. linear ft.: ) Page 2
7 Manufactured home utilities 110.00
Cross street/directions to job site: g O e: �1 Manholes I 16.60
/
1 u-cf to & Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subtiivision:54,,'nrrat iti-Al'?... (Lot n� 0.
Water service (no. linear ft.: ) Page 2
/ �� /' A / pt or Item
Tax map /parcel no.: ( f - Absorption valve I 16.60
vj ,/ DESCRIPTION OF WORK Absorption Backflow preventer Page 2
SC: ape, .% r o / q i haze fjl.'Lfw G/e i e .? , Backwater valve L 16.60 0 17 _S
Clothes washer 16.60
Dishwasher 16.60
d. PROPERTY. OWNER... I ❑ TENANT Drinking fountain _ 16.60
Ejectors/sump 16.60
Name: buy; ywyy-/ S S f_ # Hpn t'-S Expansion tank 16.60
Address: 1 1 , , , / 3 C . .S U - 1 & - z - 4 - ( c 4..0 0 oc.k, Fixture/sewer cap 16.60 l
City/State/ZIP:( x /ICe, Ow c76 O/`. y 7 b 3 5 - Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
APPLICANT • CONTACT PERSON Hose bib 1 6.60
'
Business name: 1-
Ice maker 16.60
b
/-4-4 el S CJ1f -e, (_W C /OY .Z " Interceptor /grease trap 16.60
Contact name: `� .
C. � �. p Lk-i 'CL6 Medical gas (value: S ) Page 2
Address: d � • --C)O . ti) /YIvS.. /rsrlw t Primer 16.60
City /State/ZIP: &h , J2 . -• I .76:(0 Roof drain (commercial) 16.60
Phone: (503) & C/ ---S- 5 I Fax: : (5;"3) 6 f01 - G'A'S" Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
_ Urinal 16.60
• CONTRACTOR Water closet 16 60
Business name: n�SCa�jL ? _9(,n ��) C, Water heater 16 60 I.
Address: f 6,)-,>00 S W !Y1 � S•l.G l.A.1 12.p Other:
�, 7 ,4 it £ -) U Q S
Ci /State/Z1 � 7 U�
Minimum permit fee: 572.50 34,- t
Phone: (3) (plja C ' Fax: (5 £9a e 07a 3' Residential backflow minimum permit fee: $36.25
CCB Lie.: 7 KN./ Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized igntl � 1 7 State surcharge (8% of perm :t fee) e1. yo
TOTAL PERMIT FEE 39 , ( S
I Print name-:// e .S ,2c,- )1J I Dat - 7_ 0S This permit application expires if a permit is not obtained ssithin
/' 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
11 BulldingtPermiu%PLMF- PemmAppdoe 12/03 440 -id PST(10/0LCOM/WE9)
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CITY OF TIGARD
BUILDING DIVISION t- PERMIT #: PLM2005-00628
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/2005
Phone: (503) 639 -4171 X170 I t
Inspection Requests (24 Hrs.): (503) 639 -4175 ,._' - e
,
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 4:11PM PAGE: 69
SITE ADDRESS: 12790 SW WILLOW POINT LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 020 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Baclflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7536
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503692 -5945
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 019565.02 503-692-5945 N
Corrections /Comments / Instructions:
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(PASS Ft -' - TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL r CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: D ate: i • � - Phone #: (503) 718-
,
CITY OF TIGARD �
BUILDING DIVISION PERMIT #: PLM2005 -00528
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/2005
Phone: (503) 639 -4171 4040111\
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 4:11PM PAGE: 70
SITE ADDRESS: 12790 SW WILLOW POINT LW CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 020 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 - 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503. 692-5945
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 019565.01 503.692 -5945 N
Corrections/Comments/Instructions:
Op
❑ PASS ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-