Permit • - r.
( A CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -10036
..� �l DATE ISSUED: 3/21 /2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA - 11100
SITE ADDRESS: 12984 SW PINE VIEW ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 2 LOT: 100 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 COMM • Description Date Amount
4230 GALEWOOD ST. STE. 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/5/2006 $36.25
[TAX] 8% State Surcha 4/5/2006 $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: Permittee Signature: ���p
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.
Mar 21 06 09:46a Ellen
503 - 692 -0768 P.2
1 Buildingyiatures . •
Y iumlbing Permit App .1 ,-. .i i EIV
'� \ _ FOR OFFICE USE ONLY
City of Tigard Received _
13125 SW Hall Blvd., Tigard, OR 97223 Daffy 4 . , Al , ' ►t�� Permit No.� \ p - od
Phone: 503.639.4171 Fax: 503.5981960 Plan Review
24 Hour Inspection Line: 503.639.4175 MAR 2 21-"'
Date/By: Other Permit No.:
Internet. www.cr u rd or us �' I .. Date Ready/By: Juris
In See Paget for
Notrfied/Mothod:
+,+3i P 1 2 1 \ } t tic tS �r r Supplemental Information
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�] New construction ' • n :. ,
■ Demolition For special information use checkllsr.
❑ dition/altera/acement 0 Other:
Adtionrepl Description Qty. Es. Total
.t L rz y,,_ i � lio re ��.,- ,� c �, 3 Y ri , r y New 1- 2- family dwellings (includes 100 ft. for each utility connection
la:f:icJt .!tzti:: c + `a-i ±"_ a.- an,i.. "7� t J.z I : J ,]'-� r. i i r r u. `^ . 0 i m .,. SFR (1) bath J I y )
-g., 4� i� lie _...: .:t?:? i ' rR- Y.,f n % 249.20
\` 1- and 2- family dwelling ❑ CommerciaVindustrial SFR (2) bath 350.00
❑ Accessory building 0 Multi family SFR (3) bath 399.00
❑ Master budder Other: Each additional bath/kitchen 45.00
l „ �,l tom. - 1r-_� jrrr V. r z Fi 1, y3 c Fire sprinkler
. c" 't r, � . " �'�' V.T . Kv n i f iPN V I Il� J i i . T It ,7Sti i i- ',IF .s4 y "" � eri . 'e • q1 /§} sP ( sq. ft.) I I Page 2
v .L_ .tom �.- _.U.._� .,_, . �.v�;af liels .fir il: -.1: 'a ?L`�4, , . .r., " •.�''r .1r` ' Site utilities
Job site address: / a l g'•/ E.:4 A ,; p fl e. V i i-c..) Sr Yre g drain 16.60
City/State/ZIP: - Catch basin or area ran 1
��
7 iga_i c O A. e •
� r � 4 e� y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project nanj' uyl/h ( fe e t e X00 Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
.P-0 1QC'e C r /�0 Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Pagc 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision;S4ryyrn�. /2_c.[lee..., l Lot no./O3 „ Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: ID 5 Ii
Fixture or item
' ",�, so valve 0
[ 1� # Absorption v v 16.6
� r � ,'. ��+'I` '�t��� po- •�'..- 1 i • � a�:. ? l.r ,t, M1 T:�' �' ,,, i� "'.Yr�u
' � . , pi' 4'; . ; :..,: „ " iSe 'S i ! Backflow preventer / Page 2 ,2"'") �� 'Sl- � %Sri 1 �/- m h e f o;,6 d el) / e; , Backwater valve 16.60 SS
Clothes washer r 16.60
7"0 1 �sU c ma r Dishwasher 16.60
3'11 �t•� .( Sy', =� -F c , �� "+� `1 r f �A l y n Z `� :.?', r �'R ` p riog; . Drinking fountain 16.60
,.r ,�0 :- izz f._.-:.° -d- , x 17� K4:ii' �g ,.. y y , r f Fr ':`, � ' .;: ; X 7. °
Name: DoZ'1 �/ 'A..-iii. ' . E 1
Jri ss t° f f / 16.60
J Expansion tank 16.60 1
Address: Lia 3 c .„S 1.0 G << ( c.o 0.0z:1_ Fixture/sewer cap 16.60
City/State/ZIP:Lpr_. /C C) j . ?U (3,0._. ei • )3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) J Fax ( ) Garbage disposal 16.60
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_... ��,i. c9,.�� Jri. +�;.cCF�•'� :tS� =
�r-��t��s ['� � �.'" 19 rtyli 'zi i � N�' Hose bi b 16.60
Business name: La j) C S (1 Ice maker 16.60
/
.Z,Z
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Contact name: Interceptor/grease trap 1 6.60
CZ ( :r (.._,
f '� zr acr6 Medical gas (value: $ ) Page 2
Address: / 3-() S.-() rn J -I al' l..j AD Primer 6
J 16.60
City/State/Z]P: ,+�, � °7G (commercial) 1 6.60
-� (Y1r (} Roof drain commercial
Phone: (Se 3) ( -S I Fax: : (5'5) (, l - 0 '� .S, Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
r C' , '�' E-mail: l: i J a,,r e, i s , _ Urinal
� 7 ° q i tb yfL4f -, j4. r ; y .R4j � f H, � } r J i° s . : . :4 Is`nr h 4 i o,•; 16.60
:.i i..kr.. - '` ii, r.: s 2 .r , . ,,2 ....t . l'i; �;:o Water closet 16.60
Business name: 4 41Se.ei ^� O rU � �� Water heater 16.60 r•
Address: l �'Gt3 (( NI �'r 7- q p
- c l.c .: 1 .. . _ Other: _. _ .- --.
• ._ _ - _ l -_ _ ..., . .. _ i • _
City/State/ZIP: ;r ,�•-?� joie �,7U�; I _ Subtotal
Phone: .3) tY /v_�j .' Minimum permit fee: $72.50
OZ 9ys Fax: (5173) t , 9a - `74 8
0` Residential bacld permit low minimum peit fee: $36.25 36 .r s
CCB Lie.: 7 to I Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sign %t�ulr� State surcharge (8% of permit fee) a.� 70 .
Print nante`/ TOTAL PERMIT FEE 39 , !�
�.'CL1 Z L) I Dat /6 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.
\ BuildinsV 'anizAPt. Perm6tP.pp,doc 17!03
440-461 6T(1 nenico W WEni
CITY OF TIGARD /L"7
BUILDING DIVISION PERMIT #: 2004 —(o 3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / - I j?- tiL 1c-3 >1 t CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 -1 7 - 0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
•
;II PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /14/4 Date: / Phone #: (503) 718 -
V