Permit j V. '!
CITY TIGARD PLUMBING PERMIT
r,71 It DEVELOPMENT SERVICES PERMIT #: PLM2005 -00310
_,�1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/14/2005
PARCEL: 2S109DA -12000
SITE ADDRESS: 12968 SW KOSTEL LN ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 109 JURISDICTION: URB
Project Description: Install residential backflow prevention device 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 # 100
LAKE OSWEGO, OR 97035 [UPLUMB] Permit Fee 7/14/2005 $36.25
[UTAX] 8% State Surchu 7/14/2005 $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 50 ' 9 : ' 00- 332 -2344.
Issued B 4 I Permittee Si natur ,.' ; /iii
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.
r'
tt . L
Bu Mixtures
Plumbing leri(n]L " °111,�i°�'all't'U 0� E l•? FOR OFFICE USE ONLY
nit-‘,-, „® n p ._ 11
City Of Tigard Received
eiv / �7 OS i¢i� I Pernut tJo.: , AiW� I t J -
13125 SW hall Blvd., 7lgard, (11; 07223 0 1 Inn; Pl ar. Review pt(r rmit No
Phone: 503.639.4171 Fax ax 501.591.1 960 .1. ti 4 /t om , I 1 Date /By:
24- Hour inspection Line: 5(1;.630 4175 Y OF TIGA.- C�/ I + . _ Date Ready /S B S Page 2 tar
Internet: www.ci tigard.or.us GAT , tte+t aer Notilied/Method: y: ( Supplement al Informa
T1;PF�l(t) ll'1'l2Utvtvcv• - F. * S IEDULE
New construction Li Demolition For special 'njormation use checklist.
Description I Qty. I Ea. Total
❑ Additionialteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
C:A I'E(ORY OI% CONSTRUCTION SFR (I) bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOIt SITE INFORMATION AND LOCATION Site utilities
Job site address: j ; . i ( [ i ' L � ■ k2' i sy--7'c €/- Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg /apt. no.: [ Project 11ami'Li y.iv f- i te,(f�� /cq Footing drain (no. linear ft.: ) Page
Manufactured home utilities 1 10.00
Cross street/directions to job site: Manholes 16.60
SL.L) g C C -( J j eft C( /<.I) Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
•
Storm sewer (no. linear ft.: ) Page 2
• I Water service (no. linear ft.: ) Page 2
Subdivision LTV) /Vi L.1 Kt P C/ -C% I Lot no. :1 o 9
Fixture or item
Tax map /parcel no.: S /1
-,_ _ - _ _- Absorption valve 16.60
i)Esc:RfkTl(N OF WORK _ _
Backflow preventer / Page 2 7. SS
/_,-:„.; „-„ �, . . ,'^i: C' /.e 7 /(1)' „,„:4,,-,,_;,,,,,,--.: " Backwater valve 16.60 •
f Clothes washer 1 6.60
•
Dishwasher 16.60
Drinking fountain 16.60
EL PROPERTY OWNER , El Ejectors /sump 16.60
Name: J . : . .. - . " ..- .. Expansion tank 16.60 .
Address: L-7/ -) 3, , - ,. . / r' . .. ' ,1 04 t Fixture/sewer cap 16.60
City/State/ZIP: , , , _7(', .C..ice % j (.,'. S Floor drain /floor sink/hub 16 60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
-- Hose bib 16.60
1 APPI.I(.: .NT U. CONTACT PERSON
Ice maker 16.60
Business name: ;_!T.; /1 ; 7 ' ; / - -. % /i!'�,�) T'-i r Y : Interceptor /grease trap 16.60
Contact name: J ) ... _ , (. J`. Medical gas•(value: $ ) Page 2
Address: ' .1. (' . ( !, ' ; i. i Primer 16.60
City/State /ZIP: - -" ; ,;; ;. , ,; • 1/ J ! 7 (. (./, ) Roof drain (commercial) 16.60
Sink /basin /lavatory 16 60
Phone: (_> ;) ::. ' - - - .' ', Fax:: ( 3) ;'.;1 - C. ` /(- -' _
Tub /shower /shower pan 16.60
E-mail: - - . _. _- -- - Urinal 16.60
('ONTRA(:TOR _ Water closet 16.60
Business name: ! , - , / . / : , . / - ; . ,--:; -i /2 /;T: T:l r Water heater 16.60
Address: - - _ ' i' t.,< ice\ Other:
r'. - Subtotal
City/State/ •r Lu -. i ..;" ",?,,;'11, - i 0 : , = ' '" , G' . - ;ti-- Minimum permit fee: $72.50
Phone: • ,r-f.,` ) ;i: / :. `I __ ' Fax: l- -', y) ,� 9c? [�7 (0 g Residential backflow minimum permit fee: $36.25 . 3
(' (p . a_ S
CCB Lie.: 7 ;'i':(_.
(_) = Plumbing Lic- no.: Plan review (25% of permit fee)
State, surcharge, RO,_ see, . 4c
Authorized signet _ _ _` % .,•,.// % `; % ice � I y TOTAL PERMIT FEE I 3'1, / S
Print uame!t j/ -'1 it_i, °-'? ' ` Da7 i 1 3 i 0 This permit application expires if a permit is not obtained within
l 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
i \Bu,IdinglPermis'd' .MMF- PcnndApp doe :2.01 440- 4616T(I 0 (02 /CONI/WFB)
a - d /39L0- Z69 -EOS u eL =LO SO ET InC
Sep .20. 2005 11:02AM CLEAN WATER SERVICES 503 6814439 No.9232 P. 5
• Permit #:05 - 002781 - 00 - P1
C1eanWatcr\Services
sw Hillsboro Highway nspection Request Line: 503 -681 -4444
2550 Hillsbro, Olt 97123 4 hour notice required for fill inspections
Ph: (503) 681 -3600
Project Name: SUMMIT RIDGE, LOT 109
Project Address: 12968 SW KOSTEL LN Issued By: Nichole Vanderzanden
Type: Snni /SWM Connection Issued: Jun 29, 2005
Single Family Expires: Dee 26, 2005
Project Description: THIS IS ONE OF 7 LOTS THAT TIGARD MISTAKENLY ISSUED PERMITS FOR. THIS PERMIT
IS BEING SET UP WITHOUT FEES. TICARD HAS ALREADY COLLECTED FEES AND THEY
SEN'1" 1'HE CHECK COVERING WHAT WE WOULD HAVE CHARGED TO SUE REYNOLDS.
Owner Applicant Contractor
DON MOkISSlTFb HOMES INC DON MORISSE'Cl'E HOMES INC NONE
4230 OAI,EWt )OI) # I00 4230 CAT.P.WOOD 4100
LAKE OSWEGO OR 97035 LAKE OSWEGO OR 97035
Number of Equivalent Fixture Units (FU)...........16 Number of Sq Ft 2640
Treatment. Plant. ..... ,,,,,, ,,,,,, .....Durham Water l7istrict. ...,.,,,................... .......,.,,,..,.....,., Tigard
TOTAL
I HEREBY CERTIFY 'I'HAT'I'HE ABOVE INFORMATION IS CORRECT.
SIGNATURE: Date:
I).ON
moRissvvrE HOMES INC
CITY OF TIGARC •
II BUILDING DIVISION PERMIT #: PLIVI2005.00310
13125 SW Hall Blvd., Tigard, OR 97223 ,..- `' L
DATE ISSUED: 7/14/2005
Phone: (503) 639-4171 ..:ttliit
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7120/2005 TIME: 7:11AM PAGE: 43
SITE ADDRESS: 12968 SW KOSTEL. LN CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT #: 109 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE NO. 2
DESCRIPTION: Install residential backflow prevention device, for irrigation.
OWNER: D i ORISSE I LE COMMUNITIES LLC, PHONE #: 503,357-7538
CONTRACTOR: . NDSCAPE OREGON, INC. PHONE #: 503-692-5945
Oale
Inspection Request Scheduled For: 6 , Date: 7/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011782-02 503-692-5945 N
Corrections/Comments/Instructions:
. .
•
t....PASS 11 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
Fi FAIL El CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED.
YIA
Inspector: Date: Phone #: (503) 718-