Permit ..t.„ CITY'OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: P 4/2005 -00191
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/4/2005
PARCEL: 2S 110BC -03200
SITE ADDRESS: 12455 SW WINTERVIEW DR ZONING: R -7
SUBDIVISION: THORNWOOD LOT: 003 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 LLC
4230 GALEWOOD ST Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 5/4/2005 $36.25
[TAX] 8% State Surcha 5/4/2005 $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: j.Q,° Qs /.Q
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. 4
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.
.,
Building Fixtures RECEIVED
Plumlbin2 Permit Application FOR OFFICE USE ONLY
City of Tigard MAY 4 ZQ I ` R ate / yJ y f p Permit No.� \`►,„led 5 1 1
13125 SW Hall Blvd., Tigard, OR 97223 Date/BY
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
CITY OF i' z,:,r ,i_ iJj Date/By
Other Permit No.:
Re
24- Hour Inspection Line: 503.639.4175 a
Internet: www.ci.tigard.or.us BUILDING DI r - • r Da t 1 S See Page 2 for
NotiSed/Meta d: Metho� Supplemental reformation
- - TYPE OF, O • WORK . ; FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist
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 (1) bath 249.20
1 730- 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:
f Fire sprinkler ( sq. ft.) Page 2
i k r ys - . JO_S�Sli* .L• Site utilities
Job site address: f,2 V SS S (d) W i et_fer 0 e„ ,)/q - Catch basin or area drain 16.60
City/State/ZIP: . 7"/ qa../Let_ G / t. 9 7 s-2L/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name:77_ )c 'cL LOT 3 Footing drain (no. linear R.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
ce ' g„Gr ,�" "",� ,� Manholes 16.60
I,�-C p--0 N RI) Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
t
Waer service (no. linear ft.:
Subdivision :'Tf - )d - y &w�jC,GC, Lot no.: 0 3 ( ) Page 2
Fixture or item
Tax map /parcel no.: L s( �.�, Absorption valve 16.60
• DESCRIPTION OF WORK . Backflow preventer Page 2 , SS
Lamd SCape. /rr/ 90- -a70 i hC[C.if - Ji /e iLx. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
-: 13P)ti ERTX WtYER: , - _ Drinking fountain 16.60
n Q Ejectors /sump 16.60
Name: ) t VY) Dy7 S S C.-1-# k / ,eS Expansion tank 16.60
Address: Lf o"Z 3 O S u.J &-( &Lk) O oC.L Fixture /sewer cap 16.60
City/ State/ZIP:[ .J< e DS w t.q0 OA- 9 7 C) 3 5 Floor drain /floor sink/hub 16.60
Phone: (. ) / Fax ( ) Garbage disposal 16.60
fiPP IC ` Hose bib 16.60
. •' .. ).4 11 ` ' . 1CONTe . ;:i ;RSON -
Business name: Lail a S -. or Ice maker 16.60
�/ /��/ Tin G Interceptor /grease trap 16 60
Contact name: Eli ) S alr Medical gas (value: $ ) Page 2
Address: / a -00 „.a} l L(�� Primer 16.60
City /State/ZIP:11E4 7, o , 1 70(0D- Roof drain (commercial) 16 60
( 3) �9t9 - 5- 9C/5� (Sa3 6 FA ( > Smk/basin / lavatory L6.60
Phone: 0 Fax: - G 7
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
. ' CONTRACTOR . - Water closet 16.60
r
Business name: Lai eiS cetp Orr' n -0,- G Water heater 16.60
a
Address: / • - i ) S W NI Lf � / g Other
City/State/ZIP: 4. •4 70& Subtotal
V c�,,, 69.2 Minimum permit fee: $72.50 as
503) 3
Phone: ) &O 9 /5 603
Qa S' Fax: 69.2 ' - O7, Residential backflow minimum permit fee $36.25 3
CCB Lic.: P lumbing Lic. no.:
Plan review (25% of permit fee)
i / State surcharge (8% of permit fee) oZ . 90
Authorized signa x TOTAL PERMIT FEE 3y• !S
Print named'/ ei) _r Dat�gs.J / 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.
FABulldingmPemoutPl.MP- PermitApp doe 12/U 440-45 I 6T(I0N2/COM/VEB)
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CITY OF TIGARD i
BUILDING DIVISION PERMIT #: PLM2005.00191
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/4/2005
Phone: (503) 639 -4171 ,, I
Inspection Requests (24 Hrs.): (503) 639 -4175 iom!,�, 1 4- R-_..
INSPECTION WORKSHEET FOR DATE: 5/18/2005 TIME: 7 :16A PAGE: 15
SITE ADDRESS: 12455 SW WINTERVIEW DR CLASS OF WORK:
SUBDIVISION: THORNWOOD LOT #: Q03 TYPE OF USE:
PROJECT NAME: THORNWOOD
DESCRIPTION: Backflow device.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.692 -5945
Inspection Request Scheduled For: Date: 5/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 007203 -01 503-692-5945 N
Corrections/Comments/Instructions:
•
[PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Datet Phone #: (503) 718-