Permit CITY F T I GA R D PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2006 -10023
DATE ISSUED: 3/8/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DB -03200
SITE ADDRESS: 13126 SW HAZELCREST WAY
•
ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 070 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 SW 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 : 503 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: "7,�,( r i - r -- Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. 1 �
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.
wilding Fixtures p EGEIV Ell
Plumbing Permit Appl d •
FOR OFFICE USE ONLY
City of Tigard MAR 8 2OO Received
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: - . >S Pcnnit No ?\ AOl � 4 3
Phone: 503.639.4171 Fax: 503.598.1960 / iari G',• Plan Review W U
24- Hour Inspection Line: 503.639.4175 L 11p . I � Date/By: Other permit No.:
rip Internet: www.ci.tigard.or.us
CITY O F 11 ""`'x" 1 � Date Ready/By:
i q me l r % T ,r C,-,, s 'p u 2 . L �..L R �m Notified/Method: S see Page l Information
rnet www cr
11!I Y44 Y t �� { t� ( ;t7 �� { E, .t7 , Ea see Page 2 In£orrna , ,
� , ^ s SC`1�rr„ W„ liim t,f131�,�i t :i �A " o n 9 ' i9 �1,. �y 5 ` ' ' ` .''p .r t� i 7r°, ( i t;"5 - gc:t . ,' t ., 3 a t a t
... . :.ri. , 1sr . ? i.1 c oP t, ;t : "t i /� (�`',(,, �JL:' � .: • ti,.: i/;6 14 .'' ^Y % ".
..o,: i�34,1�tl'.�. tY(Y:l / {,:.i ilt ;:•�tYt•..1i F.'II L ::lfr4i�i,•. 3 U1.ry., .,,,,. •
'
• New construction ❑ Demolition For special information use checklist.
SFR (I) bath
Description
❑ Addition/alteration/replacement j Qty. Ea. I Total
❑ Other:
,aS�t r'3 ft . ;r ;rl viP�'� t �� T New 1 -2- family dwellings (includes 100 ft. for each utility :.: tl ' t/ t fai t, r r Yq 6'1 - ¢'0 1.m r 97•
IT,. ' ° - .,-
' �� i.,s da: 'r..•.a:9c >' 1S'a'i i�1'!' d rk 1 . ' i,.. d�L i << +::
a . connection)
j 249.20
1 - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
0 Accessory building ❑ Multi-family SFR (3) bath 399.00
Each additional bath kitchen 45.00
❑ Master builder 0 Other:
1 � ' r l '4 . d1 ^ e Fire sprinkler ( s ft.
r
a�R" ct .2 : :.a2 ir -. 7 A '�i' 1:V . -- � . Dti + j� '.W . . J-4 ' . s 5 .. V : +k „ ' Site Utilities ) - I Page 2
Job site address: 3,(z SI)) 7
ei«�rT LoCf -lam Catch basin or area drain 16.60
City /State/ZIP: � A C 4� 9 7 / 1 � Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project J -) j - i ;� Footing drain (no. linear ft.: _ ) Page 2
Cross street/diirectionstreet/directions to job site: Manufactured home utilities 1 10.00
L) 2)c- t1-' 1 2114&._o 12,0 or Manholes 16.60 - -
�
Rain drain connector 16.60
3 - y� '"" T---(11-4 CC Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: ELL/I) m cl-- Ri tL9 I Lot no 1 Water service (no. linear ft _ ) I Page 2
( g
Tax map /parcel no.: tip S Fixture or item
tt/f+' .lLt•} "�K • +r i � n ' � j ���,� ,r, .- '4 , .. rr y , at: i .Y., {.,,,, ,;,,;,,, n Absorption valve
S.•,i. °.'tfaAa,.Y 'itTtargit.i!4i;is�;l TtY3.ei ?1 �j, a Y ; `.;i.: ' ,Y: 1: �ili : i,. i .....^ I 16.60
a + { . :::`i & ;.`: :i iitii.ii),ila Bacicflowpreventer
-I
' Page 2 P.. / , ss
04 sc_ tp., i rr / 9 J 0'2.1 b.t'J,/, ( -104,) ,;/ _ / a . Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
�
£ ,/
? 7.5"ii ;�; ry tiff*1 � 21°_ r ?t)';rr n ittlgriii:', • § i1: i., Vs':' 114 �/ ..; .,'4it i r . Drinkin fountain
:Ui;L:t,.:., r ',c r • sly t fo ar. g 16
k,r :a ila'i %,. , " 4' 1.4 ' ::. ;,' ''' 4 :'S. _
[L
Name: ) 3-)- �/�/ SS L f f Haw e-j . Ejectors/sump pansi 16.60
Address: L! vZ 3Cj - Expansion tank 16.60
6 <<. e. e �i � Q 'oct. Fixture /sewer cap 16.60
City/State/T.IP :( -JC 0 S - i_U ( 7C) C) 0 k- G/ /V3 J Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: Fax
�^ t � ( ) Garbage disposal 16.60
r i t t' t Si f';W74".'.'C r g 9'airiti i7 )..1 / w pl . "7iN11 5^ t ,a' x"a' rt• -�-Uw
> ' YV ; 1 ?r ? a ' , ., f -: ' . °� ,•(1.1;:x: I ma e
� .:�: n , :;- ,4•. d !�. r ''.1'•51:11 , .,� 16.60
Business name: a �y�C e, 0p"P / Ice ma ke r 16.60
/ i' � l i �� `� Interceptor /grease trap
Contact name: El en �f f 16.60
e
Medical gas (value: $ _) Page 2
Address: / 3D () .,(1.) Mt i (Z Primer
16.60
City/State/ZIP: T 1 /i � , 02_. c 76' (0 Roof drain (commercial) 16.60
-
Phone: (S63) �w� - 9'75 I Fax: : (5.a3) &, FcR _ C/ 26,..k
Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan
16.60
`,n; § r�:t *fitf`z �['H! = ra.r�.. ..- Urinal '
s. r ' ,74 i1 ar,::r
;.e{s( /'.;. fin. a` _r ;.t t.; 1 6.60
'tf', r13,4: ^•'r, i V'.43$133$', e" - 1 . C. le�:'...i
" w . . , .. s it.,,, , c ?K; 5 'ki'• � ? ° . '' :.'. ' ..:'. � , , ;r; ;:N', .> Water closet i 16.50
Business name: Lan _S
y in) Cy Water heater _ 16.60
Address: / - - - oo ,S14) N1 Ll• •,•- . ; g.43 Other
' City/State/ZIP: ; -� .%/
y ��G. ° �/� V� �!L'‘O -�- 1 �'_..... -.._ Subtotal
Phone: 6 /!!
3) Y,,Q -S i S (z)9c;? Fax: (G3) 1 Minimum permit fee: $72.50
7 C - U7(p a Residential backflow minimum permit fee: $36.25 .3 6- ;)--S CCB Lie.: 7 go Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signa L �� n n � State surcharge (8% of permit fee) c. . �/C'
' vr TOTAL PERMIT FEE
Print name-' �-��11 D ..,, C I 3 • ii S
I ' p --C(4' I This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board
is NBuilding \PerrnitsNPLMF- PermitApp.doc 12/03
440 -461 GT(10 /02/COM/WEn)
2 -01 89LD- X69 -EDS Ua1 et7t 90 8D JeN
•
CITY OF TIGARD RECEIPT
DEVELOPMENT SERVICES RECEIPT DATE: - -' ..F -_
�,t�yw,yJ!i ww
13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.: ) ((.5-- 503 639 - 4171 w.tigard or.gov CASHIER DATE:
CASHIER RECEIPT #:
LINE ITEMS: •
Case No. Fee Description Revenue Acct. No. Amount Due
49 6
1
Total Due: $
❑ SEE ATTACHED FEE SCHEDULE.
PAYMENTS:
Payer: \ c5\r,s. s
Method ' Initials Ch4ck No. ! Confirm No. Amount Paid
:se:
Total Paid: $ 3q. /5°
I:\ Building\ Forms\ ManualPermitForms \ManualReceipt.doc 03/01/063/7/2006
CITY OF TIGARD V L (21
BUILDING DIVISION PERMIT # QQ - /Oc 3 _ ;
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 '' i�1j
Inspection Requests (24 Hrs.): (503) 639 -4175 ��� V:_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 31 D-4, . i - / , i / CLASS OF WORK:
•
SUBDIVISION: LOT #: Y .----
TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 a 7 -0 co Pour Time:
Code # . Inspection Description Confirm # Contact # Message
399 ,PLC-/ 9,:). -59e-its`
Corrections /Comments /Instructions:
( (---
►; ' A'ss ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
III FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r' 2 I ,V l.- Date: d Phone #: (503) 718-