Permit �, w
dipo CITY OF TIGARD
j� DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT #: PLM2006 -00117
�,.1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/3/2006
PARCEL: 2S 109DB -02100
SITE ADDRESS: 15048 SW BLACK WALNUT TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 059 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
Total
Phone : 503- 387 -7538
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 B y : i1 f >7 ,76 Permittee Signature: ,.e 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.
'" Buildilrg Fixtures `' 03
, ` v ► FOR OFFICE USE ONLY
Plumbing Permit A • • G� -
City of Tigard 006 Received", `� )
Datcl6y: permit Not \ J % f
p %pP
13125 SW Hall Blvd., Tigard, OR 97223 3 a Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 (( ..''���" !�t ', ,t� Other Permit No.:
' �• DateBy:
Internet: www.ci.tigard.ocus cj • (
24- Hour Inspection Line: 503.639.4175 Q� '` ow �+' t' � t14�,. Date ecVMet y:
Juris: l See Page 2 for
hod: Supplemental m i n
• . - _FEE *'SG'FIEDULE' r ..
❑ Demolition For special information use checklist.
New construction Description I Qty. Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility conneeuon)
:;CATEGORY O F,CONSTRUCTTON SFR (1) bath 249.20
(� 1 and 2- family dwelling ❑
Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler (___. sq. ft.) Page 2
,. ". J:Olit S1 FE `1NFORMATIO])L . &ND LOCATLON " Site utilit
Job site address: / SU Li k cu IS) (;C LGG W G< Q i'11xT A ee, Catch basin or area drain I l 16.60
U /� 7
City/State /ZIP: -- / - 7 (t�_CC
2_- a t/ Drywell, leach line, or trench drain 16.60
Cj
1 1 k, emE Se) Footing drain (no. linear fl.: ) Page 2
Suite/bldg./apt. no Project n ./1' it L f Manufactured home utilities 110.00
Cross strect/directions to job site: Manholes 16.60
. ' f-v 13 C Li Pail-r) P-- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
/ Q , Water service (no. linear ft.: ) Page 2
Subdivision: S (,'Lrn WI ti" et (- _ Lot no
Fixture orp Absorption Tax map /parcel no.: ( e 16 60
• Page 7
Ab orpt
'' 1DESCRiP 'QF WURK Backflow preventer / age 2 • / ; _ r :; o.1-!� ' � ' ' . J -J : . („ Backwater valve 16.60
�.(.�� �/' ll_ if � rr,� _ /.:� '_;,
Clothes washer 16.60
Dishwasher 1 6.60
, ...,. 1, :,, ii .. rin fountain • Pl20PERTY; OVV . .. r ;.: -;, . •i �1 IkNA11 . ..... 'i , '.....
D king f 16.60
•: ,. � . :,. Ejectors /sump I 16.60
Name: D (-r ('fl (TY1 .S �• ' Y "_.:.- (.0 Y1 IfLL./LLti CS Li .xpansion tank 16.60
•
• Fixture /sewer cap 16.60
Address: �-f,1 � C ` S L U L ^= � ( c i_ LI < t�(
a ' • 4 H Floor drain/tloor sink/hub 16.60
City /State/ZIP:L._.c� /<<. L% \ L>,1 t < C; L'�- "� /(- _'
Garbage disposal 16.60
Phone: ( ) Fax: ) Hose bib
maker 16.60
.
LXCAN
.P T • ' , , ... - ..... ,.. . _.:. ,. Ice �'�CONTA 1'ERSt1N"
Business name: LC( f ( t f, /°t . f ), -- r j!, , ). 1 „ C.
Interceptor/grease trap 16.60
/ Page 2
Contact name: - ! � ... /1 ...S I i i••' /',L" Medical gas (value: $ )
� , 16.60
Address: / 3 (.) (: S (,r!. /YI tf / ( YI t .j 0 Primer J J Roof drain (commercial) 16.60
Ci /State /ZIP: - 1 � . ` -
CY � "� �7 � X12- / • Sink/basin /lavatory 16.60
Phone: (St! 3) C /_ - -=-� /Y c) Fax: : (_ 3) i- ..• ;
c ' '' '‘ . 16.60
Tub /shower /shower pan
E -mail: Urinal 16.60
c set
•':, :'s.. , .: .� �: ' :.' ,;:; "..', .. - . .. ,.. Water heater 16.60
Business name:`_!. f)ds( c2 _ t . ;, ,-, /� j--� _%; ! _
...r..•:,. - I • I Other.
Addre.,.: ;• , ci _ J 3-.,.,...1 1 , - f` -_ _ Subtotal
City/State/211 7 7 • (( 6(. -t C) . �f /(Jl^ ' - /� Minimum permit fee $72.50
Phone: ewe �3 J teQ, S .SA Fax: 603) 67 � - 0 7 (c. g R es id en t i al bacicflow minimum permit fee: $36.25 3 L -
7 � Plan review (25% of permit fee)
CCB Lie.: Plumbin Lie. no.:
State surcharge (8% of permit fee) r >c1)
Authorized sipta J 6 ( _/ 'Gt! _ TOTAL PERMIT FEE 3 ../ S_
''`j
Print name . � "O V1`�� �f G I This permit application expires if a permit is not obtained I rian
/, I' j 180 days after it has been accepted as complete.
*Fee methodology Set by Tri- County Building Lndustry Service Huai o
is \BuitdingW nits\PCLtF- PermitApp.doc 12/03 440 -46 16T(10 /02 /C omivin3)
a' d B9LO- a69-EOS uaII 3
al al :IO 90 TE Jew
CITY OF TIGARD
BUILDING DIVISION PERMIT #:p�jyl � 001)7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ai i l i I
Inspection Requests (24 Hrs.): (503) 639-4175 ':_
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: /50 / g NaCX I V Jr t 301 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: Q
OWNER: PHONE CS 6/`)-- /�--' S_5�5�
CONTRACTOR: o��e PHONE #:
Inspection Request Scheduled For: Date: 1 - 5- 0G0 Pour Time: •
Code # Inspection Description Confirm # Contact # Message
35 ga.c .-Plo 4"/ be.v ; cL ce •
Corrections/Comments/Instructions:
T�..e s / 0 # -S
•
6
•
.
.
pi. ', SS I 1 PARTIAL APPROVAL ❑ CANCEL E NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �Date: / �� Phone #: (503) 718- �� Z
,