Permit 4 CITY OF TIGARD
PLUMBING PERMIT
: COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00412
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/7/2007
PARCEL: 2S 109AC - 05900
SITE ADDRESS: 13168 SW NICOLE LN ZONING: R -7
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SUBDIVISION: WILSON RIDGE NO. 2 LOT: 027 JURISDICTION: TIG
PROJECT: WILSON RIDGE NO. 2
Project Description: Install backflow device.
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
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Owner:
FEES
STONE BRIDGE HOMES NW LLC
16869 SW 65TH AVE #505 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 9/7/2007 $36.25
[TAX] 8% State Surcha 9/7/2007 $2.90
Phone : 503- 387 -7577 Total $39.15
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Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -5945
FAX 503 -692 -0768
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued _ ��_ Permittee Signature:, / / / /J ,. G fI
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Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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IW 10:33a Ellen 503- 692 -0768 p.2
Bonded - Insured
, .r it E\JED
e;i • O V 200 Received L nae�ny t 5 Permit ho.: p(.M ZQ'9 ' t�-(Z 5 Hall Blv ` •i ' r .: .,. ,, Plan Review
Phone: 503.639.417 . . t - •�t .: '-', . I .I Date/By: Other Permit Nn.:
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24- Hour Inspection Line: 503.639. 75 , ) F Y t, - 'I I� Date Ready /By �J: lB See Palle 2 for
Internet: www.ciiigard BUIW l Notified/Method: it Supplemental Information
TYPE OF WORK - , :: FEE' SCd3EDUl.$ ..
• ® New construction ❑ Demolition For special hrfonnawkvn use checklist.
Description I Qty. I Ea. I 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
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building 1:1 Multi-family SFR (3) bath 399.00
Each additionalbativkitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 13168 SW Nicole Lane Catch basin or area drain 16.60
City / State/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Wilson Ridge Phase 2 Lot 27 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: -
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Wilson Ridge Phase 2 1 Lot no.: 27 Water service (no. linear ft: ) Page 2
Fixture or item
Tax map /parcel no.: 655 A7
Absorption valve 16.60
DESCRIPTION OF WORK Backfiow preventer / Page 2 0l7 . SS
Landscape Bacldlow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
121 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Don Morissette Homes Expansion tank 16.60 •
Address: 4230 SW Galewood Fixture/sewer cap 16.60
City / State/ZIP: Lake Oswego, OR 97034 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) . Garbage disposal - 16.60
0 APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Landscape Oregon, Inc- Interceptor /grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: S ) Page 2 '
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Address: 12200 SW Myslony Street Primer 16.60 •
City /State/ZIP: Tualatin, OR 9'7062 Roof drain (commercial) 16.60
Phone: (503) 692 -5945 Fax: : (503) 692-0768 Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet • 16.60
Business name: Landscape Oregon, Inc. Water heater 16.60
Address: 12200 SW Myslony Street Other:
City / State/ZIP: Tualatin, OR 97062 Subtotal
Minimum permit fee: 572.50
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 Residential backflow minimum permit fee: 536.25 ._ • o • CCB Lie.: 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 02 : cip
Authorized signature: TOTAL PERMIT FEE 3 ! , l S
' I Print name: Ellen Sparrow Date: 09 /07/07 This permit application expires if n permit is not obtained within
180 days after it has been accepted as complete.
phone: 503.692,5945 • fax: 503.692.0768 • 12200 SW Ms1'gIlti 4do siIBi1Feleir•'d ei4g1p 1b' service Board.
i:. Buildiny\Pemiu`'PLM- PenitApp.doe 06:05 440- 4616111202'COWWEBj
CITY OF TIGARD
i l BUILDING DIVISION PERMIT #: PLM2007 -00412
13125 SW Hall Blvd., Tigard, OR 97223, DATE ISSUED: 9/7/2007
Phone: (503) 639 -4171 :VII?'
Inspection Requests (24 Hrs.): (503) 639 -4175 .,' F:_
INSPECTION WORKSHEET FOR DATE: 9/25/2007 TIME: 7:00AM PAGE:
SITE ADDRESS: 13168 SW NICOLE LN CLASS OF WORK:
SUBDIVISION: WILSON RIDGE NO. 2 LOT #: 027 TYPE OF USE:
PROJECT NAME: WILSON RIDGE NO. 2
DESCRIPTION: Install baddlow device.
OWNER: STONE BRIDGE HOMES NW LLC, PHONE #: 3- 387 -7577
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 60
Inspection Request Scheduled For: Date: 9/25/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 056292 -01 503- 692 -5945 N
Corrections /Comments /Instructions:
(<8.,S7.1) %•ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL - LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ■„.■,_ Date: .7%SX 7 Phone #: (503) 718 -C'
Imp-