Permit CITY TIGARD PLUMBING PERMIT
-,'�� j I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00646
�.� DATE ISSUED: 11/22/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -08200
SITE ADDRESS: 12982 SW HAZELCREST WAY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 076 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 11/22/200E $36.25
[TAX] 8% State Surcha 11/22/200E $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
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: � �� I Permittee Signature: J rt,-
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.
L,
Euilding Fixtures �V
Plumbing Permit Ar m
�n
ll� a FOR OFFICE USE ONLY • •
City of Tigard 2 0 0 0, Received
1 13125 SW Hall Blvd., Tigard, OR 97223 ,f� J DateBy:/ f ' �G2 �� Permit No.:'
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review��� U y f
��
24- Hour Inspection Line: 503.639.4175 CITY OF "°rl ^ li f \ DateBy: Other Permit No.:
Internet: Www.CLggard.or.us LN o V A � 1 . Date Ready/By: furls: O See Page 2 for
RIM.. -0 Notified/Met od: 17(f I Supplemental Information
E TYPE Or WORK FEE_ SCHED[ILE
New construction ❑ Demolition For special information use checklist.
❑ Addition/alteration/re Description
I Qty. ) Ea. 1 Total
Addition/alteration/replacement p ❑ Other:
New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath
249.20
IN1,1- and 2- family dwelling ❑ CommerciaRindustrial SFR (2) bath
El Accessory building SFR 350.00
❑ Multi - family (3) bath 399.00
I ❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORlS'LATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Site utilities
Job site address: / qg AZ S:4U 2_6/
E'�C (it si wQ.0 / Catch basin or area drain 1 6.60
TI
City/State/ZIP: / q cL 0,2._ 9 7 a� / ( Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project rat L{ rytrn L-.1-. 7 / Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: 4 J Manufactured home utilities 110.00
S-10 6e_L L �,L� ,� Manholes 16.60
1 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: S LLrnyyt (.� /2--i-ct q t:,/ 1 Lot no. i7 (, Water service (no. linear fl.: ) ( Page 2
Tax map /parcel no.: Fixture or item
(SS `
• DESCR ION OF WORK Absorption valve 16.60
ff
i /... Backflow preventer Page 2
tz, ,, jd. ` / 6�, i l-/%/ i r Bac / of S
C 1 l: / q _. ! t : �!!_� 7 ` c %Y,_.' i ! Backwater valve 166 .60
Clothes washer 16.60
Dishwasher 1 6.60
Q PROPERTY. OWNER L Cl, 'TENANT Drinking fountain 16.60
Name: /s try Ejectors /sump 16.60
Expansion tank 16.60
Address: 3 c_' S Liu 6,,....,;_{ e. c_ .0 C) c ,,-
Fixture /sewer cap 16.60
City /State/Z1P:Lez. fC G 0.C, L.v e l` :, "; 72._ c-/ '7 Li Floor drain /floor sink /hub
16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
'APPLICAM1T • fl CONTACT PERSON Hose bib 16.60
Business name: /f 1 -;6 - i �:L[ � tv 0/ ^ ^ . Ice maker 16.60
P . hrterceptor /grease trap 16.60
Contact name: ✓) / `✓) , ; u ; Y -" , :
t Y Mcdica] gas (value: $ ) Page 2
Address: j 0-0 ) ( ' } ,, I
°'�' e ^ 1 J � t or i2,0 Primer 16.60
i ( r, . ;.. ,. . ..��
tl 1 ,!� v Roof drain (commercial) 16.60
City /State /ZIP:
Phone: (,j6 +:3) (.G 9 j"jcic I Fax: : (So 3) ! ;',4 - C ,/' , f.- Sink/basin/lavatory 16.60
E -mail_ Tub /shower /shower pan 16.60
- Urinal 16.60
CONTRACTOR
_ _ Water closet 16.60
Business name: / t , ) d_S ri_l.i , L r�, e. i/(_):11 ' C Water heater 1 6.60
Address: (. ,;.I...,' ..� �/G ��) � ci n (J
; � / . t ; l� Other:
City/State/Z1P; /� F--� ✓// 4 -5".:(70&
ids B/ -72_
Subtotal
Phone: () lP� 9 ( Ci.3) 6'? . 0 7( gr. Fax: Minimum permit fee: $72.50 t_
Residential backflow minimum permit fee: $36.25 3
e 4' • S _
CCB Lic.: 7 g-U Plumbing Lic. no.: I Plan review (25% of permit fee)
:u :c °red sigtlarfr L 1 t/ _ State surcharge (8% of permit fee) c.2, 90
Print name y �/ S`i,i _ I TOTAL PERIv1IT FEE
l•! �� l d.(,� I Dat11 1,j I US 1 This permit application expires if a permit is not obtained n ithin
J 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
ilBuilding ■Permits \PLMF- PerniitApp.d 12/03 •140.4616T(l0/ObCOhUWED)
T' 89L0- X69 -cos ua1I e62 =60 SO 8T AoN
7
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: PLM2005-00646
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/22/2005
Phone: (503) 639-4171 A:11Itilit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/23/2005 TIME: 7:00AM PAGE: 58
SITE ADDRESS: 12982 SW HAZELCREST WAY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 076 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: BackflovrpreveitelThlifibblion. )
OWNER: DON MORISSE I I E COMMUNITIES, LLC, PHONE #: 503-387-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 11/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 022321-02 503-692-5945 N
Corrections/Comments/Instructions:
/
r- 1 .. pASS PARTIAL APPROVAL fl CANCEL 0 NO ACCESS
_
FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ATSSED
e
Inspector: Date: -- 5 Phone #: (503) 718-
_, --
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00646
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/22/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 i„,,dollii �
INSPECTION WORKSHEET FOR DATE: 11/2312005 TIME: 7:00AM PAGE: 59
SITE ADDRESS: 12982 SW HAZELCREST WAY CLASS OF WORK: '
SUBDIVISION: SUMMIT RIDGE LOT #: 076 TYPE OF USE: '
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: l cl air a ter foil iiiigatiori.
OWNER: DON MORISSETTE COMMUNITIES, LLC, PHONE #: 503-387-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
Inspection Request Scheduled For: Date: 11/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 022321 -01 503.692 -6945 N
Corrections /Comments /Instructions:
•
N pASS I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '0'.. Date: i Phone #: (503) 718 -