Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 10006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/1/2006
PARCEL: 2S 109DA - 11000
SITE ADDRESS: 12958 SW PINE VIEW ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 099 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 COMMUNITIES LLC
4230 GALEWOOD ST #100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 3/31/2006 $36.25
[TAX] 8% State Surcha 3/31/2006 $2.90
Phone : 503- 387 -7538 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: ---- Ia.& 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.
•
Baailding Fixtures
Plumbing Permit ApEIVED FOR OFFICE USE ONLY
City of Tigard MAR 1 2006 Reeaved - - -/ i(' - - --p Jj Permit (2UL WO ) ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re ll
Phone: 503.639.4171 Fax: 503.598.1960 /�4,: Plan Review
24- Hour Inspection Line: 503.639.4175 !e Date/By: Other . Permit No.:
Internet: www.ci.tigard.or.us CITY OF TIGA' ' Date Ready/By: Jut :: El See Page 2 [or
{ _ Nonfied/Method • Supplemental Information
�., Y' ti . Y N , ti7.r.,.. i.. 1 0 t ; ; r) t v 7S; i ;l t a .. nC t FW,-y� tar a t-�r.: ltrt - .7.1.r
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0 New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement 0 Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
L ` _ .. f L l7 t`Itl . a '1 I ,- it a7LL1 -. J . %
7.. �cz:4 ._ .,_ . «._: . _ ...i.. _ - -` ' �,�. ��� x .. � , Y; SFR (1) bath I 249.20
10 1 - and 2 family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi family SFR (3) bath 399.00
❑ Master builder Each additional bath/ldtchen 45.00
❑ Other:
j Fire sprinkler ( sq. ft.) Page 2
'''yrF •`.7 ' 1J1 � 71•: ? ri 4IV 1' jQ l-' { '(Tr Nw -[� _,. -. s Y tr � 3i4 .`L -.
, s �N: , _ _ _ .:. r1 , .. b'. 1...:' '-i <..L1 r �R'_1 e. 1 .V21_' 1 2.1', j J_ T1 : 7 17, Site utilities
Job site address: (a CS T 91,L� n
!" //) e V 1 e S f - rt - co• Catch basin or area drain 16.60
City/State/ZIP: '•r t q 0_, a_ 0 t __ q -7 -3{� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt no.: I Project namg`(,1,/yl lyL.1 . ` I 11 ,`• e 7 Footi drain (no. linear ft.: _--) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
S �) n e e �p Manholes 16.60
!� & � 1. Q 0 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: yi kyt '. /2�_a4 if, I Lot no.: q Lr Water service (no. linear (t.: ) Page 2
Tax map/parcel no.: S.s Fixture or Item
l0
m
7 ,, fi ,yr a �r t74,1l i ;' nc o' ai 4 t j , �° Absorption valve 16.60
t: a X ,' r ._ sir;: r - .y. a ` � )tf( , �CtW'?<,z, , ,il} ,,...r '.., -,
Backtlow preventer / Page 2 �-7 s5
64sCape /rr/ , UY1 hcLC1cfloci) c-te.v /e.t", Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
L 3 rrJJff ?s' Drinking fountain
'4r� a�i'?I�11 d 1 Ih ,Ga�9��� � ' '({ 1 � �1 i� .:e 7 ��rt • D
g 16.60
1' . '''
s . _ ° z,: k > •. c f.. __.5._x�,� f'� t f . z1_ Ejectors/sump 16.60
Name: bCY1 Yr) !Tr/ SS e-f-f T g4 CQYTI/MI,t tL ri:Cs
Address: /� �� Expansion tank 16.60
v_ 30 s w Glc (e. e.e.3 0 6CL Fixture/sewer cap 16.60
City/State /ZIP:[c _ / fi e O S' tli t1 OP-- . 703 5 Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
�r r 4 '� v I .i :-,...,:.-,17,;t z � i r �;i�� 1 ' .I_ n 7' � Y q d � � i 1 7 r : T 1.� f Hose bib 16.60
Ice maker 16.60
Business name: S C�O G OYP_ -
(m .Tel C , Interceptor /grease trap 16.60
Contact name: el) en ,,,,Sr CLT` Medical gas (value: $ ) Page 2
g
Address: / 0- -DQ .S-w rn i/S-I n y 2D Primer 16.60
City/StateJZIP:� , , 012 ' e l 7O /„ 3) Roof drain (commercial) 16.60
Phone: (503) (i7 Q62 -S9( 5- I Fax: : (S'3) , Fa - G /7 r Sink /basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
r � f s �7 Q . ez � f 7 y ny a � L Jr a .: �, Urinal 16.60
1 a jr.lr77 F �i f�lti 7 f .t '1�- ., -'.. 16.60
.t,...,.r. . ,_,. . �, _,,,:..�.� �� .. .1_..L1�.t:�tY_ <;:s 'a•J6.� ' �.:', � - 43.,0.. 4 -..,., Water closet
Business name: ')t ei On- 'q�m -z.,-) r, Water heater 16.60
Address: / ,p---6,f) S "" (,v � ) 26 • - - other:
tty,Scate/zIP: /1 02 we Z - -- - -- - - -_ - - - -- ; ..oral - -
//� Minimum permit fee: $72.50
Phone: 64 3) (Q S'9jS Fax: (503) (09.? - 07 (D If Residential backflow minimum permit fee: $36.25 34,. ;/...S
cut Lie.: 7 g-t> Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signs State surcharge (8% of permit fee) 1, 9 )
..„-.40a4.-4,..er-47 TOTAL PERMIT FEE 39, / r
I Print name8m `1 I Datf 3 / 04, This permit application expires if a permit is not obtained , ithin
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
iA8uildineernitaL mF= PennitApp.doe 12/03 440- 4616T(I0/02/COM/WEn)
T' 99L0- 269 -EOS u e0E =TT 90 TO JeW
CITY OF TIGARD dam �ZZ
BUILDING DIVISION PERMIT #: 2 DOCo — /DO c3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Az gt'll �I(I
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 1 a ' 1 5 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 (" Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 q °1 eo-ii F-6,0 Corrections /Comments /Instructions: •
1. 4111/ wir WV/
❑ PA ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: AVATAL Date: 315-(e4) Phone #: (503) 718- ���