Permit CI TY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00650
-,,'' . � I �I DATE ISSUED: 11/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DB - 02200
SITE ADDRESS: 15026 SW BLACK WALNUT TERR ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 060 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 11/23/200` $36.25
[TAX] 8% State Surcha 11/23/200` $2.90
Phone : 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
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: �� Permittee Signature: � (•1"1
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.
Buh'idlnig Fixtures : yam {�py�
ti- ,�9•y�t, i5•�N'+usrF + H v'ra^v 1� t �•`t A
p� ^nI[ ]I�ITrtl� l��IT' ➢ll>t ) �QIl�a1 iQAf[Il,( a �/ 1 t fFOR^>IOF�FIC�E 111E ON ,Y �� :>ti :Eer • .,1;
City of Ti ardl Received - i e • g � f �0 5 Date/By: ,_ �' . ' / Permit Nob \ \ h.., � "0 / 6 [ J 0
13125 SW Hall Blvd., Tigard, OR 97223 l u� , -. Plan Review \ V v
Phone: 503.639.4171 Fax: 503.598.1960 yv� _ /�a „•;y� . „ i t\ D y:
Other PermitNo.:
2 p ; 1.�lj
Fl our Inspection Line: 503.639.4175 I _' • _ ' Date Read /B °ru' See Page 2 for
Internet: www.ci.tigard.or.us '°" � ' ' ` "` Ready /By: j� Supplemental information
g ra-CY O� ,, ii1n Notified/Method: �t � information TYPE OF WOullt41(Al-D1 b L' JJJ
FEE* 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
•
-N. " , q1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION. .AND LOCATION _ Site utilities
• Job site address: / r3�j ..) Pyt CL./e__ LL Catch basin or area drain 16.60
City/State /ZIP: 7f' e,LAc � (, /2. ' 7 ? Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project n . t fn 12A...4 cy C cod, Footing drain (no. linear ft.: ____) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16 -60
st-L) L) _L___ " lS: Rip .. Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _ Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision yN y- - f-LC{ Lot nc( C-..) Water service (no. linear ft.: ) Page 2
(Fixture or item
Tax map /parcel no.: U. ec
�7 Absorption valve 16.60
DESCRIPTI N OF WORK Backflow preventer / Page 2 O7 , $
1
t 1 Backwater valve 16.60
���t; .SL' G�.1fi ! (-- r - i 0 �J � ! %r'1 ;%;G. �.: 1-104) %- t"s1 ! l � .
i/ r
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain
Q. P�2OPERTY, OWNE12. I . ❑ TENANT
' Ejectors /sump 16.60
Name: D 6)1 iiotirl S`S -/-7 /-fCw^ le._s Expansion tank 16.60
Address: Lfa 3 C,r S Lc Cilz.(e. t.-k..3 Ci Oct. Fixture /sewer cap 16.60
City/State/ZIP:LL'je c C).S i_0 C.%0 0,Q. 2. 5 4- Floor drain/floor sink/hub 16.60
Phone: ( ) / Fax: ( ) Garbage disposal 16.60
' P:Ppi,ICAN7C CONTACT PERSON ' Hose bib 16.60
" - Ice maker 16.60
Business name: b. :14n ,r /°(' /_%` (. .0/,-;...f. fir / "b'1 LI'
I / 1 Interceptor /grease trap 16.60
f /
Contact name: elf i , t om 04,- Medical gas (value: $ ) Page 2
Address: 1l a --.O U .1- ..) � m ,,..1„s.,' gyi L° D Primer 16.60
City/State /ZIP:1 - 1„ f yL Cl 0 , - 7 _�(_,( ,� Roof drain (commercial) 16.60
1 r - Sink/basin/lavatory 16.60
Phone: (Se 3) (G CJ ji - - - 2 6{ j Fax: : (,5 L, y .;K (
- ' J(!' , }` Tub /shower /shower pan 16.60
E -mail:
__- Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: , }.L 07/71` ?07 7E7: G r Water heater 16.60
Address: -) f Other:
Subtotal
City /State /ZIP: ' . 6 --)il `104 '47040 �� Minimum permit fee: $72.50
Phone:( 3) i ,R . 5 Fax: 503) ( o .[) 7(p gr . Residential backflow minimum permit fee: $36.25 3(...,.. 3(...,.. CCB Lie.: '7 Ei G Plumbing Lie. no.: i Plan review (25% of permit fee)
Stale surcharge (8% of permit fee) , . CI0
Authorized sigzta ° 0 .
` ✓G--E '( ✓ e.:6 ./1,/ff -�(, I ] TOTAL PERMIT FEE 39 i S
Print name `l er') ,c. /;;/, 7 ,. ) D13.1.' - 2 -0 S 1 This permit application expires if a permit is not obtained "s irhin
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
i. \auilding \Permits \PIMP- PermitApp doe 13/03 440 -1G LGT(10/02'COMJWEJ3)
E' B9L0 z69 -EDS uaii3 e62 :60 SO BT Ao.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00650
13125 SW.Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/23/2005
Phone: (503) 639- 4171 1p�igy���l?I
Inspection' Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/7/2005 TIME: 7:00AM PAGE: 105
SITE ADDRESS: 15026 SW BLACK WALNUT TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 060 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Bacl preventer for irrigation.
OWNER: DON MORISSEfTE COMMUNITIES, LLC, PHONE #:
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
Inspection Request Scheduled For: Date: 12/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 023021 -02 503-692-5945 N
Corrections /Comments/ Instructions:
•
4 1.7
cf
1
o elr" . 7pllimr/W
f
' S \ ARTIAL APPROVAL ❑ CANCEL n NO ACCESS
11 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: W) Date: \ J Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200 006 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/23/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . !.
INSPECTION WORKSHEET FOR DATE: 12/7/2005 TIME: 7:18AM PAGE: 106
SITE ADDRESS: 15026 SW BLACK WALNUT TERR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 060 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Baclflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES, LLC, PHONE #:
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
Inspection Request Scheduled For: Date: 12/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /back low preventer 023021 -01 503 - 692 -5945 N
Corrections /Comments /Instructions:
z A pp .
PASS 1PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspectorj�/ 77 Date: /3 7)7 7 " Phone #: (503) 718-