Permit C ITY OF TIGARD PLUMBING PERMIT
oil I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00468
,.i 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/1912005
PARCEL: 2S109DB -02800
SITE ADDRESS: 13097 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 066 JURISDICTION: URB
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 Description Date Amount
4230 GALEWOOD ST. STE. 100
LAKE OSWEGO, OR 97035 [UPLUMB] Permit Fee 9/19/2005 $36.25
[UTAX] 8% State Surch< 9/19/2005 $2.90
Phone : 50.3 387 - 7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
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 -000 -! I I through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calli r • 503-246-6:19 1 100-332-2344.
Iss ed By: i 0 // 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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Building Fixtures - 15Tc9.6 11 $
• Plumbing Permit t�ppf�,t Q�;F��E - � 1 FOR OFFICE USE ONLY
•
City of Tigard e Received 0
p No
13125 SW Hall Blvd., Tigard, OR 97223 � 6 2005 Date/By: A UAW `/ rm ' --co �� 1
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 hor:,.ti , ll 1\ Date/B Ot • . 't No.:
24 Hour Inspection Line: 503.639.4175 z� r:'�( y
i Date Ready/By: apil, . S ee Page 2 far Internet: ww G 1-Pf ICST16 - 1 Notified/Mcthod: Supplemental information
�CC T YPEI" UMSIOM. F - SEDUCE
New construction ❑ Demolition For special information use checklist.
Description j Qty. I Ea. j 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 j
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
Each additional bath /citchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( , sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION . . - Site utilities
•
Job site address: / 3 v9 S t 1-ae ( ,-tom/ - ...S.472 Catch basin or area drain 16.60
City/State /ZIP: -r u , _ O 2 9 7 v-PA t/� Drywell, leach line, or trench drain ` 16.60 .
Suite/bldg. /apt. no.: !! I Project name; ju-mtv a lei 41 t� e/ Co Footing drain (no. linear ft.: ) Page 2
(t Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
.S- It, 2 t-C 1 6Ule-t_ R--p. Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
�ynMLe-- �� d4 , 1 Lot nt
Water service (no. linear ft.: ) Page 2
Subdivision
Fixture or item
• Tax map /parcel no.: (el ,Sr A Absorption valve 16.60
DESC CON" OF WO • • Backflow preventer 1 Page 2 1- . S S
L_-p)4 . C / (i I (Y/ 90:h Cl? T7c- /C 11.1,1,) ,....--,/ et; / ,:,::::f Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY. OWNER • I • . • ❑ `TENANT
Ejectors /sump 16.60
Name: t'� oi n /, Ym, -' S S f f / /? ') e_ S Expansion tank 16.60
Address: L f 3 c ..S Li....) &e7 e. -'CR) O Oct_. p Fixture/sewer cap • 16.60
City/State/ZlP: L -/< C • OE Lu C 7C) OIQ. ! . % D.3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60 • APPLICAN• CONTACT PERSON
Ice maker 16.60
Business name: L g ( ?L . oKeCf Tai Interceptor /grease trap 16.60
� t9 i
Contact name: Lai :Sp a ritznki Medical gas (value: S ) Page 2
Address: / -PC.) ,� U) / yi S/ ay (2.1) . Primer 16.60
City/State/Z1P:' 0� (a , O P-. . J 70 0 Roof drain (commercial) 16.60
r �. t .. Sink/basin/lavatory 16.60
Phone: (50 3) C / (i . C9,: l 2 -- S% (/ S Fax: - (S 3) & / _ G ,7(o .,..
Tub /shower /shower pan • 16.60
E -mail: Urinal 16.60
CONTRACTOR . Water closet 16.60 /.,
Business name:� .� ore_ylln �„I C, Water heater 16.60
// Other:
Address: /,?-;,D--00 S (.0 fp, LIS/1 1W
Subtotal _
City/State/ZIP: -") 0 ,Q 70 7 -
/ ""' Minimum permit fee: 572.50
Phone: 6(23) (ega S'91s Fax: 5-€23) ( 9) e 07 (j, ' Residential backflow minimum permit fee: 536.25 36,. aS
CCB Lie.: 7 SOU Plumbing Lie. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 42 , 90
Authorized sign ( � �l �Ci� TOTAL PERMIT FEE
Q 13y./S
Print name �I _Ls? Dat� - /La • O S This permit application expires if a permit is not obtained „ithin
"11 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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CITY OF TIGARD _
BUILDING DIVISION PERMIT #:
PLM2005-00468
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
9/19/2006
Phone: (503) 639 -4171 r IN a
Inspection Requests (24 Hrs.): (503) 639 -4175 ,� �,I ..
INSPECTION WORKSHEET FOR DATE: 9!22/200 J TIME: 7:12AM PAGE:
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 13097 HAZELCREST WY LOT #: TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE 066
DESCRIPTION: SUMMIT RIDGE
Dackflow preventer for irrigation.
OWNER: DON MORISSEI IE COMMUNITIES LLC, PHONE #: 0.3-387
CONTRACTOR: -. PHONE # 503-692-5945
LANDSCAPE OREGON, INC. •
Inspection Request Scheduled For: Date: 9/2212005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /frackflow preventer 16387 -01 503. 692 -5945 N
Corrections /Comments /Instructions:
0.);?; ...---.(" ....
,,.`. C 3"5' - 1 -- -e - s - 4 r 7 3 0 g...,,,.,
,SS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
,