Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00172
e ''i' • 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/27/2005
PARCEL: 2S 109 DA -02400
SITE ADDRESS: 15187 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 001 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 Surcharp 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 50 •-.699 • -800- 332 -2344.
Issued = : L � 1 « 1 Permittee Signatur
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.
1Pfiunumlbuu1g Permit Appllne ttn®>m 1/x r ). 0 F rea..1�LY ; 7 �, , , 4.
City of Tigard Received ■
13125 SW Hall Blvd., Tigard, OR 97223 APR 6 Q� Date/By: N tir ' Permit No.; 1 �
�� .115)/79- 7
Phone: 503.639.4171 Fax: 503.598.1960 r&,, , + Plan Review
r 1(�.yy, �i! Da[rJHy: Other Permit No,:
24- Hour Inspection Line: 503.639.4175
CITY OF ?• FYI
p r 1�
Internet: www.ei.tigard.or.us rra .. Date Ready/By: j 0 See Page 2 for
y� TTggT� A�pp r� ���� ^A T NotifiecVMethod: IG, Supplemental Information
TYPE f��`5�ft7C FEE* SCHEDULE
• CI New construction ❑ Demolition For special information use checklist
Description j 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
LI 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi - family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( • sq. ft.) Page 2
JOB: SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 57 e'7 , LO C. > re ec l . - F 1 ' { -1 a_, II Catch basin or area drain 16.60
City/State/ZIP: - 1 - 7 G �,t_ct_ o it y 7) �4--i Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ( Project name it." An E9(5/..2.-, Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
S LL) P e ef' ,� er AD Manholes d 1 6.60
Rain drain connector 16.60
LrYt1 tir of S LA.) S LL.rI l r,--) p.._.L C • . 'Y`[.. Sanitary sewer (no. linear ft.: ) Page 2
CL.. /164 Etc) G/'C - - ? c :( D L � Storm sewer (no. linear ft.: ) Page 2
Subdivision: S./icy) /1•/l. y f-- k'ciQ . Lot no.: Q / Water service (no. linear ft.: ) Page 2
L Fixture or item
Tax map /parcel no.: to --&-iel 7
Absorption valve .16.60
DESCRIPTION OF WORK Backflow preventer / Page 2 ,D 7 . SS
Lar) sC`_C/ e.� err/ 7" C/ t cm 06,Le j /r;2(.,I % ;/i N Backwater valve 16.60
LoC.Ci.-fC,4 o t () corner c-F I Q Clothes washer 16.60
N eXt - to t t 1Le.CL C�.�a- -f-rs- rnfit,' Dishwasher J 16.60 • E 'PROPER'TY OWNI R. Drinking fountain 16.60
❑ TENANT
- • Ejectors/sump 16.60
Name: ein ,s/M S S l HCM e S Expansion tank 16.60
Address: L-fQ 3 o S LC 6 e - Z - 0 ccI. Fixture/sewer cap 16.60
City/State/Z1P: 0.c w .e.<70 Ok. .733 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 • AP Pt.t(.:AN3 CONTACF'PERSON • H ose bib 16.60
/ - - Ice maker 16.60
Business name: (11-an Ct . eft in_ t, /oi- Q .1 Interceptor/grease trap 16.60
Contact name: Ell A t
Page C� i t �-o� , S i p �4-�P �Z.t_, Medical gas (value: $ ) Pa e 2
( 0
Address: -() O ,- } ' / ALP 0 Primer 16.60
City / State/ZIP: ,ice,` 6247. A., 0 2 , -' ' 7 G, (a Roof drain (commercial) 16.60
Phone: (� 03) (C C -.S9u, 5 Fax:: (52 3) « Ufa - 6 7C,
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
•
CONTRACTOR _ - Water closet 16.60 .
Business name: n4.'SC O7 W ater heater 16.60
JUi! ems) G
Address: / ?..-,D.-00 S f rt r . €t ,?, Other:
City / State/ZIP: ` $. �e"� '0�, 70� .. subtotal
" Minimum permit fee: $72.50
Phone: � 6'<4",,, s ' Fax: 603) (,9Q e 076,2g Residential backflow minimum permit fee: $36.25 3 40 "`ZS
CCB Lie.: 7 t)L / Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized sign ll �. . ; ✓� 0 �� State surcharge (8% of permit fee) a • yD
v . L ',� TOTAL PERMIT FEE 39 . /S
Print name/ fiCa•---r - LicJ Dat.t ' a 6S 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: 3 uitding1 'emaatPLMF•PcrmitApp.doc 12103 440- 4616T(10 /02(COMN/EB)
? = CA B9LO- a69 -EOS uaii3 d60 =E0 SO 92 add
CITY OF TIGARD I
BUILDING DIVISION . Y PERMIT #: PLM2005-00172
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2005
Phone: (503) 639- 4171'�l�MP�41h���i1°1i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/29/2005 TIME: 7:11AM PAGE: 105
SITE ADDRESS: 15187 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 001 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Install residential backflaw prevention device for irrigation system.
OWNER: DON MORISSEITE COMMUNITIES LLC, PHONE #: 503.387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 4/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 005592 -01 503 -692 -5945 N
Corrections /Comments/ Instructions:
DO 04 C Lc. c, V UG- L-t L.C, cc-44 Soy., rt .S S el Z —C46,-,.-.1 7 tZ let i e, S'7 / A Lae. .577"
(o;r,,•4, j _ , 60 i / S /?7 CL ve 1..,T € 4t. II,:
•
-- re .-"I' a',4.A;4-e 4- CaA.J /2c 1 TO - 4 -'V l tpvi
cr ft Lt 12-'t / D<-94,)
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 ,..f . 1) s, Date: L;/ /2 1O Phone #: (503) 718-