Permit { `L
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00171
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/27/2005
PARCEL: 2S 109DA -08400
SITE ADDRESS: 15131 SW HAZELCREST WY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 078 JURISDICTION: TIG
Project Description: Install residential backflow prevention device for irrigation system.
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 # 100 ,
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/27/2005 $36.25
[TAX] 8% State Surchan 4/27/2005 $2.90
Phone : 503- 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 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 5 - 46- 9 or -:0' 32 -2344.
Issued By: / iiy� Permittee S i natu�l���. /' yr %�
Y it 9 i.:
—
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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I:luu4ainrmg IFix�anrres FI -
IFImp:illbibng Permit ApspartgAlti9. 2005
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City off Tigard R ecei ey: ved ,/ N , . 5- I �34 M Permit No.: -p � - ! J/
13125 SW Hall Blvd., Tigard, OR 9722 �7 OF 1 �G A ry 77 / �/ r
Phone: 503.639.4171 Fax: 503.5 8, 9 45 r . , � ,. r (,� Dian y: Other Permit No.:
24- Hour Inspection Line: 503.6 {� G �WIc �. i:'(rl��
Internet: www.ci.figard.or.us . 1 JDTh � Date Ready/By: � Ei S Pa 2 or
g Notified/Method: / t , Suppleee mental f information
TYPE OF WORK . FEE` SCHEDULE
ew construction ❑ Demolition For special information use checklist
Description I Qty. Ea. [ Total
❑ A dition/alteration/replacement CI Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection) • • CATEGORY OF •CONSTRUCTION • • SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commerciallindustrial SFR (2) bath 350.00
El Accessory building El Multi SFR (3) bath 399.00
El Master builder Odic: Each additional bath/kitchen 45.00
Fire 2
.... ' F' sprinkler ( • sq. fl.) Page
JOB' SITE 'IINFORMATTON ND LOCATION
:... • .. ....:. _ :.: . _.. ............ / .. ... •
Site utilities
Job site address: 1.513 / .,ct.,�) f7 - 1 Cfr..Sir e.i__)4.7 Catch basin or area drain 16.60
City/State/ZIP: r) G/ L Q jg q 7 a._y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ! Project name:S urn iri Le- ' aye . 7 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
SC u Be e f genet. tZto Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision :. L.Lfy) /'Y) i . . ? " - leis c ..) l Lot no. 7 Water service (no. linear ft.: ) Page 2
Fixture or item
S S r
Tax map /parcel no.: Lo
/ Absorption valve 16.60 • ._ - DFSCRIIP.TIOIV OF WORK
Sack preventer 1 Page 2 a.-) . SS
1-0 sc. ape, icy/ `7 r Lei 1 hU 'fl ad G( l ! Backwater valve 16.60
9 Clothes washer 16.60
Dishwasher 16.60
., • .. Drinking fountain 16.60
` R {3L OPE ; OWNER`: ❑ T) NA 1fl.
-" P Ejectors/sump 16.60
Name: bi.yi r4O-r SS e_7 Ham e_s Expansion tank 16.60
Address: z-/-) S (� G ee• e L.C) 0 Oct. p Fixture/sewer cap 16.60
City /State/ZT�P: e, Q .S Li) •e.1.6 OR_ ` 733 5 Floor drain/floor sink/hub 16.60
Phone: ( . ) i pax ( ) Garbage disposal 16.60
.. Hose bib 16.60
El., APPLICANT .'i` 'CON'iA,CT':PERSQN, .
- Ice maker 16.60
Business name: 7 O (,/ S CC/1O< Off" a / C, Interceptor /grease trap 16.60
Contact name: 1 V ..S amL en . Medical gas (value: $ ) Page 2
Address: l � - D-DC) Sea) d 'y� I.�.� � 1 1 Le 42.0 , 1 Primer 16.60
i r 1
City/State/ZIP: -�,� f AM yL, i , If 0 2 , J 70 0 Roof drain (commercial) 16.60
Phone: CSmi3) Lo 9th --5 Fax:: (5 6 Ya - C/ 7.,:?
Sink/basin/l /shows 16.60
Tub/shower /shower pan 16.60
E -mail: - Urinal 16.60
CONTRACTOR.. Water closet 16.60
• Business name:L z /sc4.� O?-'z ! o71 j G Water heater 16.60
Address: / ?-D--00 0 �__ _- /`1 L'• 64,L4 Other:
City/State/ZIP: ` '- '4 70( e . n,...... Subt
'7, L2
Minimum permit fee: $72.50
Phone: ( C ) &gel S-941,5-. Fax: 603) 6,9.2 - Ur7 ( g Residential backflow minimum permit fee: $36.25 3 /o. oZS
CCB Lie.: 7 ezz) Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) Q , 93
Authorized signs _ ✓ <e �� -
^zr�' TOTAL PERMIT FEE ,3 , ( S
Print name /l et) ' 1J Dat L -.4„ _0 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.
i:\ BaildingWermitatPLMF- PermitApp.doe 12/03 44e- 4616T(10/02/COM/W11B)
T'd B9L0- 269 -EOS ua113 d82 :T0 SO 92 Jdd
CITY OF TIGARD -
BUILDING DIVISION
(,, PERMIT #: PLM2005- 00171
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2005
Phone: (503) 639 -4171 ' �i i ii ' il t l '\
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 5/27/2005 TIME: 7 :10AM PAGE: 63
SITE ADDRESS: 15131 SW HAZELCREST WY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 078 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Install residential baclflot prevention device for irrigation system.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 -387 -7530
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5945
Inspection Request Scheduled For: Date: 5/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 007863 -01 503- 692 -5945 N
Corrections /Comments /Instructions:
9 /
0, 0
PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL / CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:, Date: Phone #: (503) 718-