Permit CITY TIGARD - PLUMBING PERMIT
7 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00423
E ��I DATE ISSUED: 9/2/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -11300
SITE ADDRESS: 12972 SW BLACK WALNUT ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 102 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 HOMES
4230 GALEWOOD ST Description Date Amount
STE 100 [PLUMB] Permit Fee 9/2/2005 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcha 9/2/2005 $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 •
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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: 0j: Permittee Signature: ; _c, (>
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.
Building Fixtures
Pliu_ui�ia� Permit App` �I n �� ® + •
- - s, _ FOR OFFICE USE ONLY
City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 so) 0 1 � 105 Date/By: D Pemvt No ,(�„ /n��.p�; / f' -124
Phone: 503.639.4171 Fax: 503.598.1960 k+wrr t Plan Review `✓`� IN 1s�
24- Hour Inspection Line: 503.639.4175 tl -'' ( DatdSy: Other Permit No.:
[Internet: www.cingard.or.us GITY O F T-GAF .,,? � . a Date Ready/By: luris 2 c�� t El Page l i nr
r nl IU (� n�Vl NotifiedlMcnwd: Su le mental Information
I TYPE ' ,'W U{ FEE* S CHEDULE
■ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. j Total
❑ Addition/alteration/replacement ❑ Other:
New 1 - 1 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 249.20
• - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 349
❑ Master builder Each additional bath/kitchen 45.00 •
❑ O ther:
Fire sprinkler ( sq. ft.) Page 2
•
JOB SITE INFORMATION AND LOCATION
q Site utilities
Job site address: r ,D... J 7e, . l_U , l cick wQ(/u_kQ' ,- Catch basin or area drain 16.60
City/State/ZIP: T per'_ 63 ( �7 a'aL/ Drywell, leach line, or trench drain I 16.60
Suite/bldg./apt. no.: dd Project n Footing drain no. linear ft.:
Footing ia�» 1V. ( ) Paget
Cross street/directions to job site: Manufactured home utilities 1 1 0.00
n w Manholes 16.60
/12 �e f * / e j" � ieo - Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
SubdivisioLS L try /Y\.-L. {• 12.4_q/ 7 . . J I Lot no.:l al...) al...) Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: / Fixture or item
Absorption valve 16.60 1
DESCRIPTI N OF WORK
// c Backflow preventer / Page 2 a7, SS
rte /Id czt.. _if. j! - r , c 04/7 f_.; / ( {x''-l: Jf X4. l.1 ; "S // Backwater valve 16.60
Clothes washer 16.60
•
Dishwasher 16.60
• I=1, PROPERTY OWNER. Drinking fountain 16.60
. .i' ❑ TENANT .
7� Ejectors /sump 16.60
Name: FJ /y ,v) /' ; mil S S ( �• / ( J
Expansion tank 16.60
Address: '-fa 3 C- S. L.0 6-: ( e L) U oet Fixture/sewer cap 16.60
City/State /ZIP:[ / . C C . , (; i r k / G Ok_ '7 l_; .3 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
`&,,,APPL[CANT .LCONTACT PERSON • Hose bib 16.60
Business name: !^ C y Ice maker 16.60
y t
Interceptor / trap 16.60
E Contact name: � �'i' J ^ ' ` \e N J J ` /� V� Medical gas (value: $ ) Page 2
1 J
Address: l :'- DJ � .! ) n�. 1 , ,1 2.E 16.60
,+'� C.. � t Primer
City/State/ZIP:- j i i l a `� �� , -I 6. (c c-."----. Roof drain (commercial) 16.60
Phone: (SL�,_3) ` e/ -.S %U Fax: : �' t _ � 1 - �; c Sink/basin/lavatory 16.60
(52 ) c Y:.;. 7�
E -mail: Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: , eds(�� i t_. a--12:z U �,/ r Water heater 16.60
Address: /' d�-GG .t A / . r ,, L /S./ fin Lf p Other:
City/State /ZIP: '/�ef�f -7� ‘10.42.., 7U(o Subtotal
Minimum permit fee: $72.50
Phone: 663) (jq � r Fax: (5O3) / '9Q ° [� , " Residential backflow minimum permit fee: $36.25 3(s op
, -V I
CCB Lie.: 7 E--( � ^ Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized srgna li� / / State strghargo (o/ 8 of pe f l 3 1
c � � TOTAL PERMIT FEE 3y, ( ` 5
Print name`/ c/'� Lr- ) Dat !' ^ / _ c5 This permit application expires if a permit is not obtained n+ thin
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Building \Permits \PLMF- PermitApp.doc 12/03 440.4616T(10/02/COM wEB)
2' d 89LO- 269 -EOS u et70 =80 SO 52 2nU
CI T TIGARD
BUILDING DIVISION . , ' PERMIT #: PLM2005 -0c 423
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2/2005
Phone: (503) 639 -4171 /*�J�a1j , � l � l
Inspection Requests (24 Hrs.): (5 3 639 - 4175±1 .
INSPECTION WORKSHEET FOR \ DATE: 9/12/2005 TIME: 7.04Am PAGE: 98
SITE ADDRESS: 12972 SW BLACK W NUT ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. LOT #: 102 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Backflow preventer for irri ion.
OWNER: DON MORISSETTE HOME G. PHONE #: 503 - 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INCA PHONE #: 503.692 -5945
Inspection Request Scheduled For: ate: 9/12/2005 Pour Time:
Code # Inspection Description Co firm # Contact # Message
399 \ I Plumbing final 015 6.02 503 - 692 -5945 N
Corrections /Comments /Instructions:
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X PASS ❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A
�--- Date: " % ✓ p � Phone #: (503) 718 -