Permit CITY TIGARD PLUMBING PERMIT
_ _ DEVELOPMENT SERVICES PERMIT #: PLM2005 -00170
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/27/2005
PARCEL: 2S 109 DA -06600
SITE ADDRESS: 15027 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 043 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
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/27/2005 $36.25
[TAX] 8% State Surchan 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 -4 ! ! hrough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 1 3- 246 -6:! 9 • 1- 800 - 332 -2344.
)
Issued ' : . - 4,/ � / 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.
1
. � ��I.Q�IlID1g �D�C>t1lIlIl'l0s CE
IPlaurmlllQmi Fe>rirnnnt A 1 , , 01111 . . - ij i , yf . . . 0 -[ • O .. 0 - 11004110 .( 5�. -
Cg of Ta awel `, 6 Received . /I o
City g F p� . Date/B Permit No.: � �./ e/y1/7
13125 SW Hal] Blvd., Tigard, OR 97223 ` • ` u( wl
► Plan Review
Phone: 503.639.4171 Fax 503.598.1960 Yai:. 4.- •,',11∎\ Dateayt Other Permit No.:
24 -Hour Inspection Line: 503.639.4175 j v O j u'�r ". i��''
Internet: www.ci-tigard.or.us C z S �� 1 !': Date Ready/By: � E1 See Page l !or form
Notified/Method: ! `(,fit Supplemental la •
TYPE 05 1 4i�� FEE* SCHEDULE
L] New construction ❑ Demolition For special information use checklist.
Description [ Qty. 1 Ea. 1 Total
0 Addition/alteration /replacement ❑ Other: New 1 -2- family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF : CONSTRl')CTION _ . SFR (1) bath 249.20
51 ." 1 .. -..an .
- and 2 -family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
Accessory building SFR (3) bath 399.00
❑ rY g ❑ Multi- family
❑ Master builder ❑ Off. Each additional bath/kitchen 45.00
irc ( sq. ) Page
2
. " • '" '' .:,JOi3: SITE INFORMIATION�, AND . LOCATION • ' .'
spun er s
.. Site utilities
Job site address: / So ,2'7 S co (' re -6 e-fa. D R.. Catch basin or area drain 16.60
City / State/ZIP: -Ti C Ct_1C� O R- of 7 �, L(/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: / I ProjectnamegLoM k 4 gC c./3 Footing drain(no.linear t.: ) Page 2
I Manufactured home utilities 110.00
Cross street/directions to job site:
(� r n Manholes 16.60
"---3 IS e. .F 6 f'-ft(' k kb Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: S i-m rvt t..+ �..e do "t _ 1 Lot no.:/...4R Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: to S 4- ? Fixture or i tem
. . Absorption valve 16.60
I"'"''' ' ' DESCRI.PTIO OF WORK
. - Backflow preventer 1 Page 2 .,2 7.55:
lL cia 1 d ((1J cam, ,SL e, i rr•/ q j ( / t 1 ou 1 d eL1 l C-, Backwater valve 16.60
�° Clothes washer 16.60
• Dishwasher 16.60
.. _ . •.. n fountain Drinking f n 16.60
'PRbPRTi'; "OWNER` ❑ TENANT
Ejectors/sump 16.60
Name: Dpin o ss r4- .74. i W &s Expansion tank 16.60
Address: Z--/Q 30 S W G eW-A_D 0 acc Fixture/sewer cap 16.60
City / State/ZIP:[ i_J< p E ui C,qc) 0/2 / 703 5 Floor drain/floor sink/hub 16.60
- Phone: (. ) Fax: ( ) Garbage disposal 16.60
Ho bib 16.60
. `APPLICANT CON TACT:POS.O•PI,
Ice nicker 16.60
Business name: Land S, (yi -6 Or - * (; , . - C__,
Interceptor /grease trap 16.60
Contact name: 7 e,in �p (g Fib --tC• Medical gas (value: S ) Page 2
Address: 1 0 3-D 0 . - j f) ill VS- 1 MI LI , Primer 16.60
City/State/ZIP: • -1 (2 / U 2 . 1 70 Roof drain (commercial) 16.60
(S 3) & qc -- S9y5 (5 3) & ? a 76, Sink/basin/lavatory 16.60
Phone: U " Fax:: c - �
Tub /shower /shower pan 16.60
E -mail:
• Urinal 1 6.60
CON l l�AC7 OIi. Water closet
16.60 f ,
Business name: 4ti_se r�� cyre f ) -z G, Water heater 16.60
Address: / ,2-D--0,0 to r.1 L _ m j Other:
City /State/ZIP: e�P � -'04 - -70`O ,- Subtotal
Minimum permit fee: 572.50
Phone: 5.i 3) (QQ , ice ' Fax: 603) (c99) e 076, g` Residential bacle low minimum permit fee: 536.25 3 6e , DS
CCB Lie.: 7 tU Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signa _ State surcharge (8% of permit fee) 0' L , Cf 0
TOTAL PERMIT FEE 3 ? , / S
Print namea- jl ia,/ -- - 'J---C.cJ Data+ j>-tds 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:\allilding\Perrnital... rRPennitApp.dec 12/03 440.46 16r(tO /071COMNVEB)
2 '01 -
139LO- 269 -EOS uaI T3 d22 =T0 SO 92 .add
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00170
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2005
Phone: (503) 639 -4171 �uNmt�ii�n�����
Inspection Requests (24 Hrs.): (503) 639 -4175 ...
INSPECTION WORKSHEET FOR DATE: 5/1W2005 TIME: 7 :16AM PAGE: 24
SITE ADDRESS: 15027 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 043 TYPE OF USE: •
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Install residential backflow prevention device for irrigation system.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 - 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503692-5945
Inspection Request Scheduled For: Date: 6/18/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
326 RP /backflow preventer 007198-01 503.692 -5945 N
Corrections /Comments /Instructions: -
j /
/
' 1
al °ASS ❑ PARTIAL APPROVAL ❑ CANCEL . ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: frit 41 Date: 3 /4 V Phone #: (503) 718 -