Permit PLUMBING PERMIT
a CITY OF TIGARD
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00313
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/17/2007
PARCEL: 2S109AC - WR020
SITE ADDRESS: 13263 SW NICOLE LN ZONING: R -7
SUBDIVISION: WILSON RIDGE NO. 2 LOT: 020 JURISDICTION: TIG
PROJECT: WILSON RIDGE NO. 2
Project Description: Install backflow preventer.
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
STONE BRIDGE HOMES
16869 SW 65TH AVE #505 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 7/17/2007 $36.25
[TAX] 8% State Surcha 7/17/2007 $2.90
Phone : 503- 387 -7377 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -5945
FAX 503 -692 -0768
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. 4yG//]/l 9hi eC/ Permittee Signature: SOL d pj f / ( 0T1 Cr1
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.
RE Bonded - Insu t.
P[umbinP4. _ ! . D_ i FOR OiFICI USE Oi' LY
- P. - - UL 1 6 2i
CI ar t � . Received �! ` •
f Permit No.: I _ S • 50.3 g
5 SA Hall Blvd. / ' r '' /
Den/13 .
' ./f 1 Plan Review
Phone: 503.639.4171 13. ' I' 370se-vicARD . r 6(A•'I••;. Date/By Other Permit No.:
24- Hour Inspection Line: 503.639. • 5 J_ _ =•1 i D Ready'By: line ® See Page 2 for
Internet: www.ci.tigard.or.us Nnlilled.Metled: Supplemental Information
TYPE OF WORK FEB* 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- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/lcitchen 45.00
❑ Other.
Fire sprinkler 1 sq. tt.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 13263 Nicole Lane Catch basin or area drain 16.60
City /State/ZIP: Tigard, OR 97224 Drywell, leach lint, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Wilson Ridge Phase 2 Lot 20 Model Footing drain (no. linear ft.: ) Page 2
Manufactured borne utilities 110.00
Cross street/directions to job site: SW 133'" Ave
. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R: ) Page 2
Storm sewer (no. linearft.: ) Page 2
Subdivision: Wilson Ridge Phase 2 Lot 20 I Lot no.: 20 Water service (no. linear IL: ) Page 2
Fixture or item
Tax mapfparcel no.: 655 A6
Absorption valve 16.60
DESCRIPTION • OF WORK , Backflow preventcr ) Page 2 027. ,'S
Landscape Backflow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
0 PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Eje tors/swnp 16.60
Name: Don Morissette Homes
Expansion tank 16.60
Address: 4230 SW Galewood Fixture/sewer cap 16.60
City / State/ZIP: Lake Oswego, OR 97034 Floordrain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
® APPLICANT I ® CONTACT PERSON Hose bib 16.60
■
Ice maker 16.60
Business name: Landscape Oregon, Inc.
Interceptor /grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: S ) Page 2
Address: 12200 SW Myslony Street Primer 16.60
City / State/ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Phone: (503) 692 -5945 Fax : : (503) 692 -0768 Sinlubasin/lavatory 16.60
Tub / shower/shower pan 16.60
E -mail:
Urinal 16.60
.CONTRACTOR Water closet 16.60
Business name: Landscape Oregon, lac. Water heater 16.60
Address: 12200 SW Myslony Street Other,
City / State/ZIP: Tualatin, OR 97062 Subtotal
Minimum permit fee: 572.50 �C
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 Residential backflow minimum permit fee: S36.25 P •
CCB Lic.: 7804 I Plumbing Lic. no.: • _ Plan review (25%ofpermit fee)
�j j D _ , State surcl a (R% of permit fee) a . y 0
Authorized ut
d signanc �n G ✓'.``� -t ..0 TOTAL PERMIT FEE 1 1 , i S
Print name: Ellen Sparrow Date: 07/16/07 'This permit application expires if a permit Is not obtained within
180 days after it has been accepted as complete-
phone: 503.692.5945 • tax: 503.692.0768 • 12200 SW MIMongi>g1oIosy sd i1Ftitity lrt§ gt spice Board.
i; tnta ;cWg?Puavti[s PeroitApp.dne 06.05 440.4616T(IUO2/COMJWED)
Z'd 89L0 369 - 009 Uell3 dLe:1.0 LO 91. Inf
CITY OF TIGARD . jilb, 0 BUILDING DIVISION . PERMIT #: PLM2007 -00313
13125 SW Hall Blvd., Tigard, OR 97223 r `, DATE ISSUED: 7/17/2007
Phone: (503) 639 -4171 ` g t
Inspection Requests (24 Hrs.): (503) 639 -4175 . ° 1L.
INSPECTION WORKSHEET FOR DATE: 7/27/2007 TIME: 7:03AM PAGE: 58
SITE ADDRESS: 13263 SW NICOLE LN CLASS OF WORK:
SUBDIVISION: WILSON RIDGE NO. 2 LOT #: 020 TYPE OF USE:
PROJECT NAME: WILSON RIDGE NO. 2
DESCRIPTION: Install backtlow preventer.
OWNER: STONE BRIDGE HOMES, PHONE #: 503-397-7377
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503
Inspection Request Scheduled For: Date: 7/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 052886 -01 503- 692 -5945 N
Corrections /Comments /I . tructions: �
CJv `
n
Cf i•
415A -1- s .
❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
C / Ci
Inspector Date: �/ Z� � � Phone #: (503) 718- / Z