Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00065
DATE ISSUED: 2/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DB -02500
SITE ADDRESS: 15019 SW BLACK WALNUT TERR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 063 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
TIGARD, OR 97035 [PLUMB] Permit Fee 2/3/2006 $36.25
[TAX] 8% State Surcha 2/3/2006 $2.90
Phone : 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: �. �f �� �1�- �Za� J Permittee Signature: `e.
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 '.- ` ECEIVEn
Plumbing Permit Applic . 'on FoR OFFICE USE, ONLY
City of Tigard Lb 0 3 2006 Received _
`� g Date/B Permit No. `
13125 SW Hall Blvd., Tigard, OR 972 :3r ' � y y` � � � �� 1, ' ��
Phone: 503.639.4171 Fax: 503.598. 1 , . g / Received‘
�� 1� �''f�(Ilt "' I
" Plan Re Date/By: Other Permit No.:
24 - Hour Inspection Line: 503.639 �lv T G ■ I . J "� ° �'1 `��" Date Notified/Method: NNotified/Method: ed/Methn im-i' BI See Page 2 for
Internet: www.ci.tigard.or.us d: Supplemental Information
r :y. _, 7 m. ' f i f x r3cS ty A :4 <s S, T' • - >4. t to f ,: ;.
.•1 i7.�2 _ - : :: ', ;' :i•- i,'�..._' ".r .. a �: ^. �tHr. .. '- 34. la d • 5 •' .; ` V :, , a u !! • If d.+a'yle • } ;.. V.,/� .*..1'�.. :�.: ,1.71,1 r
►� 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)
r„ r { i `a (q. ^ , f 1 { rr . . , ' .i1 ;i1; „•..
sX' t ,tc a:t , , . t t t2,- ,-'sl . yw. . ; '' , , ;; • . .., () 249.20
'��. .t,�aa, :�r.G- ..� :.. i ...{.. :n. tf- ."o-�:. ; :. ,>�F,` ' , :'�•`: SFR 1 (lath
• IN 1- 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:
F " rr �1z S •f t ° ' "' i7� cm�, ° t. T J Fire sprinkler ( sq. ft.) Page 2
,,,,;, ,,r t r h uoWtl id1 tsa;o,. �'10t"1Gl fl Siteutilities
Yob site address: / 5 / q S LV gla-cie_ L,0a t LL? Catch basin or area drain 16.60
City/State/ZIP: 7 I le 4 OA._ « 7 -9Li Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project nkfitimnilet / C/o Co3 Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
-- Manholes 16.60
-'L-e) 6e-e. r Jerk' /' 0 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
/��
Subdivision; L Z /'1/M. L r "`_LLC9 [) I Lot no ,3 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: CO Fixture or item
;. ,�•. „ .. „„ Absorption valve 16.60
1
�p� ��,, �S`{ . {t:.� ::r'• . 1 •N+t 1::'4.11..^ -v.�: 1 �'J�, •. :.G.`: ; r V . lr ' .
Y ~•il; r 7 •e., 1 e"','* 4 't ? . i �� . - 0 1 a, = 1' .`' I .
zit u ll',�tih, fit,' B ackflow preventer 7 . g S
' ^� N -�" ..•:: i.so .. , � .-�'.._ • ��„ . .. „a r;€".......:krss ",�. / Page 2
L cA-n . c. - i r / , ` C con o (4 c/C ULU , ) / • Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
°ry :' t 9 b 1 1 7 4 1 e £ y'r, t' °e �vit .' t >r Drinking fountain 16.60
Ejectors sump 16.60
Name: D i rY)C1c1 SS C f ( f'-S
Expansion tank 16.60
Address: L 1 3 C. S C.LS G (e.e...c0 U 0C.L. Fixture/sewer cap 16.60
City/State/ZIP: [ -/. 0.c i LJ <'10 Q e- 4/ .7 Q3 S Floor drain/floor sink/hub 16.60
Phone: ( )). Fax: ( ) Garbage disposal 16.60
_ t '�. F9y., i s;:61`!`." L r l ',rl� 4 r ".- ; 1°tt� r gfi i ,[
✓ r Y.B',•�. a ` e 7"'p H ose bib {
ST..:....' O4.'.l -s v ot. t o r + _ f ;. L ..�o � 7 : ►sa`e7 , 1 ,y ' :i!l 16.60
� � _ Ice maker 16.60
Business name: l Ti L� S C_C• f .� or"e o-y, Z�� Interceptor/grease trap 16.60
� i
e
Contact name: l / Pn s (�`Q-r Medical gas (value: $ ) Page 2
Address: / 2 ..c.- 3 ryi(JSIMI Li RD Primer 16.60
City/State/ZIP:11 J a -ft" C 2 , 7 7( (c D--- Roof drain (commercial) 16.60
Phone: (503 (l CL - �j(/5 I Fax: : (5 (C (,q - G'��,�
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
a; at[�l : {4e. ^f', = -�. - 5 ;, 7N +�.5, :'•;.j.c.. , , : C�• ;:•:1 .•.d n+s Urinal 16.60
•"R. X .+ , 0. 744' b � .. 2i ; :: 7 •
. mil 11''k ti !.� "' ; •n '.�H r '
�'• s r.i'!' - A i a �i rir, e ' I :. .x71i"'. `1 -,v '. " i:,i`. y 9: k. : . Water closet 16.60
Business name: / Water heater 16.60
Address: ‘ ' . . - ?-,;,i.-00 ,.S ! O;he '
(� Al y l on' .
I Subtotal � 7- -_,,3-- City /State/ZIP: t�� s 7Ulo �--
_ Minimum permit fee: $72.50 //�
Phone: (53) (pQa S s Fax: (503) 60 9 - [' `7 ( g Residential backflow minimum permit fee: $36.25 3C0 - ----1
CCB Lie.: 7 e U Plu mbing Lic. no.:
Plan review (25% of permit fee)
State surcharge (8% of permit fee) 2_ 2'3
Authorized signa L ___ jipa.,,t,,L.,,e-E4.7, TOTAL PERMIT FEE 3Y , LS
Print name' oe `/ f) /,a•''j U-u 7/
-, Da t O (/ This permit application expires if a permit is not obtained within f 6 `C 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Hoard
is \Bwilding\Pemiita\PLMF.Permit.. p.doe 12/03 4404516T(10 /02/COM/WEB)
I'd B9L0 -ass -COS uai13 d20 :2I 90 EO qa3
• CITY OF TIGARD
BUILDING DIVISION
PERMIT #: am2006.000
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: MO00E;
Phone: (503) 639-4171 _ m 1
Inspection Requests (24 Hrs.): (503) 639-4175 .f.-MIP. '1,-..
INSPECTION WORKSHEET FOR DATE: 2/14/2006 TIME: 2•22PM PAGE: 37
SITE ADDRESS:
16019 SW BLACK WALNUT TERR CLASS OF WORK:
SUBDIVISION:
SUMMIT RIDGE LOT #: 063 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES, LLC, PHONE #:
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 603
Inspection Request Scheduled For: Date: -
• 2/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 026849-01 603-692-6946 N
Corrections/Comments/Instructions:
0 .
Fa - SS 1 I PARTIAL APPROVAL CANCEL rI NO ACCESS
• FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: inn i le....f Date: -- 14 I Phone #: (503) 718
. -