Permit t ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 10024
DATE ISSUED: 3/8/2006
13125. SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DB -03300
SITE ADDRESS: 13104 SW HAZELCREST WAY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 071 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 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/1/2006 $36.25
[TAX] 8% State Surcha 4/1/2006 $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: J > ��� � � Permittee Signature:
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.
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Plumbing Permit` li i 1 C jj ".L - FOR OFFICE UiSE ONLY •
City of Tigard Received /
Date/By: 3 -V ' �b Permit No.:
pp Plan Review
� \� 6 raozy
13125 SW Hall Blvd., Tigard, OR
Phone: 503.639.4171 Fax: 503. 8� 8 2006 44 ;, w:
24- Hour Inspection Line: 503.639.4175 1!14;.' 1J I Date/By: Other Permit No.:
Internet: www ct ti and onus , W Date Read B la I
g , i Ready /By: l ®See Page i Information
q�g?L�18� 5 ., �. Notified/Method:
�!3 r der ll a`r,a ai - � P i " n , Y�i�i �}J� t"K'kt'' .t 'r .r V •a. Supplemental Information
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. Lr•• 2.+r:�'tuT �t.:u":fLr ° �aY�is '�h ^ [3°38', 'Y;9.^+:�✓+3!to =�YTiI�., ai7Ji..J I'_ i:r ��'.r' ^('9 , . , T - P .. F ^'
0 New construction ❑ Demo Ition For special information use checklist.
❑ Addition/alteration/replacement ❑ Other: Description Qty, Ea Total
rcrvF,' trei�3F� New 1- dwellings (includes
r r , �. �"r,}r:,,!.b : ,�., � �� 2-family des [00 ft. for each unlit connection
• i �J 4. � p tr1. � f :11:�,r�• iar �, - N- r.•-r,; ^. v .... g (
w. if:i.' ;f•. r - il:i. - ilifxifi .;::' aY e ' ,_ 0 (• ; C, �r f�1R R 111ii +' F :,a ;yi,,�,�i,r,e; ;'::lei `.•i i Y )
r., ... ;1, o. - ' 4s ,,a , : 'F,3;'p:r .. s„s2. 16..7. ,.. • , - : .. SFR (1) bath
a z,.1814°` n
��:lH'•SSrt: 249.20
le 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 Multi - family SFR (3) bath 399.00
C
El Master builder Each additional bath/kitchen 45
❑ Other:
" .Tat* r s , r 4 t 1 ' dri �'Tfiu + �• K Fire sprinkler
t :.!1 ( ` < i /~ i r R l e P ( sq. ft.) Page 2
,��1r��`nc j 1 i� .g r t h 1'1 72�, dr b` g,i ��,� w� �t�w. a i�i � i -f . .... :, . , % t g
` P `] •�•'�` -•• ••� fl,',. Site utilities
Job site address: ! .3 /0E/ „city ! 2 L ca � ' -
Q / ! r C ol C a t c h b as i n or area drain 16.60
City/State /ZIP: T i ?a, ( C7 7 . __-(/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ` Project name Y c l - g t _ctd . 17I Footing drain (no. linear ft.: ) Page 2 {.
Cross street/directions to job site:
I ! Manufactured home utilities 1 10.00
1 p �- 7- e „�� R D • or Manholes 16.60
S ry{) / Z C"4-- Rain drain connector 16.60
r - r CZC _ Sanitary sewer (no. linear ft.: ) P age 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision GUY) Art (, j- d 9-e, I Lot no.: 1 7 / Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: ( A Fixture or item
;T a ; . n , rt.r ' °1..4 ; y F : arr ,r;;r, ':::. , .,:::rp:. , ,::•,, :. ,;,.
Absorption
yS, j #r4 S ix v X j i, Cu I Jr ' • ii:. i ;i.1:: rp 16.60
.`:� /�!;.I�����"'�'.::,A �? . 0.k � {� � � Q� �� �yy�r ,e.,f °. 1. �i: :A .�..1 -i ;.
.5 ;at
xY4fitrpn4kWiiiiF t.s'ri:a: . :.•:;;;.:iYlry " . x •;:Cti:;il;il: Backflowpreventer Paget
' l�n4 c-, 1 rr/ o ,.)-/‘ / -� y7 S
IJCI -C S�� (1 : C� ;/ � Backwater v alve
1 6.60
Clothes washer 16.60
. _ Dishwasher 16.60 ,
� �y�`� 3 <i�t7`i � ',� ,t7���� 4g� er ' „• �q�� r � g fountain
:Ur j- :•`ttIllt4:5tn,_ ib `.' • �s�ri g .r.., r B r 11T $�6 '1:• 1 4 . ' -`` r�l i i I Px97° r �,':; 16.60
ir.4 tP°!ab >,'V�_„ ,:- ! F.� : .S=`� 1 n' �dxe51 �i v � j siid "d':..''�," Drinkin fouti
Name: Ejectors /sump 16.60
6-)'1 !7') ' y 7 S S t �7 °f / y10 e. -S Expansion tank 16.60
Address: Z-74Q 3 C' S . (Ai 6't...( Q bet_ L• Fixture/sewer cap 16.60
City/State/ZIP :[ -k C 0 S i�� .t' • O A_ -- 7 03 S Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
r�mt ° y;�5 t � �� , �j � i , d{ t Rf � 7`" ,�:,r� n,;
,:�..:t•� s Hose bib
L :e:� t t ._ d r #I, dt4 Q�•.'3 - , . g �`r ✓+-f� ,''Nmm,, �,.,,,, �r�''• �i•7 ��;-�; -
r r :L L• t.ra ' t. f- .,i,fi:1 • .: i '. nir .." • gt at ftl , Fy; 4h 7" 16.60
" " '' :'' , "`" Ice maker
Business name: Loy) a S (?t 16.60
, � d 1 �� � Interceptor/grease trap 16.60
Contact name: 9 ... 62 „, ; ,..„...
Medical gas (value: $ _ ) Page 2
Address: / d a-0 () .-1.1) nivS.1 /- Li 1W Primer
`�� J r 16.60
City/State/ZIP:
'�.(�. &h it,
i'L () ( Z s -•1 76 Co ci--- Roof drain (commercial) I 1 6.60
Phone: (St)3) 112 - ,3IC/J I Fax:: (5 3) & S.',R _ 6 , Sink/basin/lavatory 16.60 1
E -mail: Tub /shower /shower pan 16.60
:,' d` ,,.CI:' , . e r .. e � . : . sa•r p r', . n .- G . • , .,,.,;. Urinal 16.60 •
4. * •ii .', - ■. i •.I+ ii,',,, a ✓: ti a�..i;: . i." ::.E /4 A!. ar,F.. : k' A,; .�� ,\ .. + : , ; �i .,,,
�.'� l'u §.,.;rX��r,;c >. � 4'... ' :!` ' :'- f.c :tFlGir, Water closet 16.60
Business name: LCL,)t;[s .t, O 7' -
t � y /� ��J G Water heater 16.60
P.,:.,'ress: / -D-- .ii2 ' s / 4) L a/%/�� _ l 2 l� Other - - --
C •.yf.• ^•..•J:II' 1Ll ,2,-o qt r '; s? '??7 �- - - -- l -._ .,Subtotal
Phone: (�(J�) ( �7y5 . I Fax: (503) /� /���- Minimum permit fee: $76.50
107 - 0 76,,8' Residential backflow minimum permit fee: $36.25 a (p .
CCB Lic.: 7 �O Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sig Aft Plumbing
surcharge (8% of permit fee) . c fO
_4 --)
TOTAL PERMIT FEE
3Y. i
Print nameE:a ef) ‘ �ai�U --� , 1 I l Data � �� � i Thi permit •.a
mit application expires if a permit is not obtained rh
`11J 180 days after it has been accepted as complete.
i \ 13 ui 7 dinglPcmurS \PLMRYeanitgpp.dec 12J03 *Fee methodology set by Tri -County Building Industry Service Board.
440- 4516T( 1 0 10 21C0.'UWI3O)
*.'d 89L0- 269 -EOS ua1 I3 eSt.=60 90 80 JeW
CITY OF TIGARD • ,i, ,. , eL'()-‘
BUILDING DIVISION PERMIT #:. 1 /bpa
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /
Phone: (503) 639 -4171 74�
Inspection Requests (24 Hrs.): (503) 639 -4175 ,._.. �I I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: l /6 4( ,, / CLASS OF WORK:
SUBDIVISION: 0 LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: I
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 —off 7 - 0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 qq "Pt/Li _ 6q -59e/5
Corrections /Comments /Instructions:
' /
( Ii i / .
.., •17.46.-.1-' .. i
I-PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL I j CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / ) L d Date / -1 / D / � Phone #: (503) 718-