Permit .
CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00173
d DEVELOPMENT Tigard, -639 -4171 DATE ISSUED: 4/27/2005
PARCEL: 2S110BC -10000
SITE ADDRESS: 12494 SW WINTERVIEW DR ZONING: R -7
SUBDIVISION: THORNWOOD PARTITION LOT: 001 JURISDICTION: TIG
Project Description: Install residential backflow prevention device for irrigation system.
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 HOMES Description Date Amount
4230 GALEWOOD SUITE 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/27/2005 $36.25
[TAX] 8% State Surchari 4/27/2005 $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 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 50' 24...99. ' -8S s- 332 -2344.
/-
Issued - : L _ _' '!J - 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.
i:, Inilldilnng IF xttanlres 1 EV ° _
]Pluumnbnang Permit Aga ' ,.r:,,, ,,, i 5 ' OC . :• ' • • .. • •
many ®>F Tigard '1005 �' nn �' ti ' � / - - -- � ,� / _ .-- - --
P R 2� Date-/By 1 147 05 fi Prnmt No.: [ S '0073
A
13125 SW Hall Blvd., Tigard, OR 97223 P Plan /t
Phone: 503.639.4171 Fax: 503.598.1960 r' ` ,(.` • '; I ; i Other Permit No.:
24 -Hour lospeetiau Line: 503.639.4175 F R � it I
0 .) , . DatrJJ3y:
••
Intcmet www.ci.tigard.or.us Ci � l y r Q \ V1 a t; j.. " - _' g
Q N Date Ready/By:
o t i T>od/Methad: S `nSee Page 2 roe
uppleeotal luformanon
• TYPE % ill WORK . FEE* SCHEDULE
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
13 Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Bach additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB: SITE „IINFORMATION .*ND,'L a ' Site udlitles
Job site address: j ,, L./ d c., c (x,11 n -1.r_4.-v ) bri u t, Catch basin or area drain 16.60
City/State /ZIP: 'T) Gi (y � a e 7 �a� Dtywell, leach line, or trench drain 16.60
Suite/bldg. /apt am
no.: !! I Project ne: 'Thar nwoa a Pare et. 1 Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
/�
Manholes 16.60
SW /3 LL C 1 M r e I i R--D Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: y nu ) OOCJ. I Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map/parcel no.: (p G 5 4 Ce
Absorption valve 16.60
• . , . . , DESCRIPTION OF WORK' Backflow preventer Page 2
I--a.n/y se a_p ri a i rr d 0)1 h fl 1 cl t �� Backwater valve / 16.60 ," 7 , SS
l� 7 Clothes washer 16.60
Dishwasher 16.60
. . . ~ -1Pii( OW! ER' ❑ TENAIP . - Drinking fountain 16.60
- Ejectors/sump 16.60
Name: Derr r)').Yi Ss e-7 f fro >vS
Expansion tank 16.60
Address: 1---1 3 0 S CU ,._(woo °cc Fixture/sewer cap 1660
City/State/ZIP: <e D S w -CIO D i2.. 1 D.3 S Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 • • ' APPLICANT 'iSi4CONTe1,C`C'P RSON: Hose bib 16.60
Business name: Lama s e F - or- -
Ice maker Interceptor/grease trap 16.60
16.60
�D•� � �') G Intercept
Contact name: ,7/ to Sp u me` c Medical gas (value: S ) Page 2
Address: i ?•a S.U0 /)1iS 5,-i !Mi Primer 16.60
City/State/ZIP:71UL - y2/• , C g_ ` J ' • (i Roof drain (commercial) 16.60
Sink/basin/lavatory 16.6D
Phone: (503) & i Qd -Sy f S I Fax:: ( 6 f a - 0944, Sink/basin/lavatory /basin avator pan 16.60
E -mail:
Urinal 16.60
."."1' •', CON RACT'OR. ,- Water closet 16.60
Business name: 4L /S � C79l'Un G Water heater 16.60
-a
Address: ! ?-D O S w I n ��1 1. RD Other.
City /State/ZIP: 7-y ` ` ere ` 47
0( Subtotal
/� e1 � �� / � Minimum permit fee: 572.50
Phone: 53) tt99 Fax: 6/3) ( /� Q - C7( g' Residential back low minimum permit fee: $36.25 3fo • D -S
CCB Lie.: 7 to • Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized si State surcharge (8% of permit fee) . �1 v
TOTAL PERMIT FEEI 37 , (S
Print name / ' I Dap , ( This permit application expires if a permit is not obtained within
c[ % 180 days after it has been accepted as complete.
•Fee methodology set by TA-County Building Industry Service Board
iAaa,'bar• glPaautAP1.INP- PerrtctApp.dec 12/03 440- 4616T(Ie/02/COM/WBB)
1' el 89L0 -269 -COS u ajI 3 e91 =80 SO G2 Jdd
ro
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00173
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2005
Phone: (503) 639 -4171 � �D t I t
Inspection Requests (24 Hrs.): (503) 639 -4175 `__
INSPECTION WORKSHEET FOR DATE: 5/18/2005 TIME: 7 :16AM PAGE: 20
SITE ADDRESS: 12494 SW WINTER VIEW DR CLASS OF WORK:
SUBDIVISION: THORNWOOD PARTITION LOT #: 001 TYPE OF USE:
PROJECT NAME: THORNWOOD PARTITION
DESCRIPTION: Install residential backflow prevention device for irrigation system.
OWNER: DON MORISSETTE HOMES, 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 007200-01 503 - 692 -5945 N
Corrections /Comments /Instructions:
t PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:, Date: ki I4 Phone #: (503) 718-