Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 10007
DATE ISSUED: 3/1/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -10000
SITE ADDRESS: 15332 SW OAK VALLEY TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 089 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 3/31/2006 $36.25
[TAX] 8% State Surcha 3/31/2006 $2.90
Phone : 503- 387 -7538 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: 4, Permittee Signature:
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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3 ' Building Fixtures
Plumbing Permit Ap. _ EIVED
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City of Tigard z
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13125 SW Hall Blvd., Tigard, OR 97223 KR R -, `` Pecmit No`.:'? \ V 0 a q
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review 1 -24067
24 Hour inspection Line: 503.639.4175 CITY OF TIG ARD ��� +at f \ Da Rea Other Permir Ho.:
Internet: www cr Ggard onus I Date Ready/By: mr
SING D�IS N otined/Method: 1 Supplemental Information
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Addition/alteration/replacement
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0
Description Qty, Ea. Total
'•F �a s� + � , New 1- 2- family dwellings (includes 100 ft. for each utility connection)
.1 ' ' ^ . . ,. E, I: ....:. eN ti �,. � fT li uIl.elf ., �iti w � 4,.R.' i.'. t , ,�,4 t ? O a �' I u �K"F f et.it i ,":14'-'..,,
___. :.�.+...�� �...�,:�'_ reE4 t et. it' y �, SFR (1) bath 249.20
• - and 2- family dwelling 0 Commercial/industrial SFR (2) bath - 350.00 '
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder 0 Other Each additional baHr/Iatchen 45.00
Fire sprinkler g
, G r l(l F t i n ro �r 7.1 I ^ F . .R r +r r :i^ ( sq. ft.) Page 2
..: , .'.: :. r• .:. Q -4 G I ,.. . V 1�b r ,,,;l f,l ,t ,re_. . Isi .
1� �s�i: " Site utilities
Job site address: (S 332. S W O -.e. VaL ie - FC_rr&.e e Catch basin or area drain
16.60
City/State/ZIP: -i- 9 0ALL Q G - 7 a-„l y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name L.t_l'y,tyl - g 9 s G Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: I '� Manufactured home utilities 110.00
S-1,1) cc-F Manholes
16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: �LUry, m - rat 4 I Lot no.:F3 Water service (no. linear ft.: ) l Page 2
Tax map /parcel no.: (Q ST A 7 Fixture or item
Absorption
"�� ?fir +p }"„+J "� sir W a so tion valve
' F d r : ri eAr4 .ay'` A I ;4f+ . k d yl a +' li s t D A } ° r r + r 3 h iai 1 16.60
,� .. r. 1 ` c i t., 3 'h ; ,- . , r4 : + nt, fi _. Backflow preventer ! Page 2 07, S
S e_ - /rr/ (1)1 I �l fiUL() e - _ ; / Backwater valve 16.60
Clothes washer 16.60
F Dishwasher 16.60
1 �S f1'; f +�y'I A I i ' +11 ". .4 C rl t _ 7 � *7,.V * � 7 . Ar !+ t - t- 7{ - y s
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,'1 -1.'.' _ L.'s , -. .. ti .?:.,, k� ti i' i . axl to ad .. *� � , Drinking g fountain 16.60
- - ....�. h. ry J...e:.•: ._- �:�.�u.+� t'.tl..'L ..tt3' �. -�lffi .�
Ej
Name: eetors/surnp 16.60
Do ()icy/ S S C f f - S CCPYlrrt4 hcs LL
Expansion tank 16.60
Address: Z--Aa 3 o S UJ I t-4-) 0 °C
't- Fixture/sewer cap 16.60
City/State/ZIP: -fie 0 S q q
/ U o�- / 7V3 S. Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
;H{ .1 r1t e 1 i d a a iir � ,P r. `7 u.. f, . e tt `�� Z'� Hose bib
.M : 1 Lr�r�'.,.c: r {I_�ilt,,. � !'..�1.` ° :s �37iz r it h :4'ffif_..l OSti.it S s 16.60
Business name: �n a 5 c l 9, 6 0`e �� I,'� Ice maker 16.60
/ e� ^
Contact name: e
Interceptor/grease trap 16.60
- I S ��Y
Medical gas (value: S ) Page 2
Address: / 2-a-(0 ..cw illy s- /twig PD Primer 16.60
City/State/ZIP: a--hi. 0 , e _ t t. 1 7G 0 ;;____ Roof drain (commercial) 16.60
Phone: (503) (p 9/ -S9y5 Fax: : (S-o3) 6 y� _ C %']�,� Sink /basin lavatory 16.60
E -mail Tub /shower /shower pan 16.60
!7st✓'1'fr {' . �q,c fir; r :rdtr2�..a.tt. a nt�7 !i "u t Urinal 16.60
r iraa t l 3 r l I � _ 1 ��,,�'p, I °v �% 1 3 ,i; r!
"J.,�. : :.,. L "._t r 1i, Li v.' � ' d` 1 bL. - _ a L .3 Y 6 , ,..3 , ' , 4:
' at .. . ` -a .. t 3 . ` Water closet 16.60
Business name: tr ai viSe t e •L r 2,-- �,
` �' ` 7 t'm ..../..) G Water heater
-
J 16.60
Address: i' l�
_.._ . ��-GG y�r'� �� 'vl:t.! Other: •
•
Ctry +StateiLi?: ,'Z0 � 4 • 0 „e Z/ / 7U10 .- Subtotal
(SU ��oZ S Minimum permit fee: 572.50
Phone:
3 =1� Fax ( 69 - U Residential bacicflow minimum permit fee: $36.25 34o-
CCB Lic.: 7 et, Plumbing Lic. no.: Plan review (25% of permit fee)
i
Authorized signs State surcharge (B% of permit fee) �, C
TOTAL PERMIT FEE 7 39' , / S -
Print name m `f f) C - , 1 1 D > 3 v This permit application expires if a permit is not obtained NV ithin
�--- � 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
is lBuilding \Pemrits\PLMF- PcrmitApp.doc 12/03 440- 4616T(l0 /02/COM/WEB)
E - d 89L0- 269 -EDS uait3 eOEI1T 90 TO JeW
CITY OF TIGARD RECEIPT
DEVELOPMENT SERVICES RECEIPT DATE: -- a
13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.: ; ' -
y ' I 503 - 639 -4171 www.tigard - or.gov CASHIER DATE:
CASHIER RECEIPT #:
LINE ITEMS:
Case No. Fee Description Revenue Acct. No. Amount Due
'Z / 7 t? CJ
Total Due: $ / 1 7.
❑ SEE ATTACHED FEE SCHEDULE.
PAYMENTS:
Payer:
Method Initials Check No Confirm No Amount Paid
13
39, ✓3
Total Paid: $ a) 7 J_
I: \ Building\ Forms\ ManualPermitForms \ManualReceipt.doc 03/01/063/1/2006
CITY OF TIGARD Pc n1
BUILDING DIVISION PERMIT #: a066 — /0 a 7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 Ii
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 3 3 oZ 62-61---L i, - I - J -4 - CLASS OF WORK:
SUBDIVISION: L #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
• Inspection Request Scheduled For: Date: 3-1 6 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections/Comments/Instructions:
PASS PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 11 M„ I∎ ' �,. Date: 3 I J Phone #: (503) 718-