Permit ff w
CITY TIGARD PLUMBING PERMIT
.4 11�� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00319
°� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/15/2005
PARCEL: 2S 109DA - 02400
SITE ADDRESS: 15187 SW GREENFIELD DR ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 001 JURISDICTION: TIG
Project Description: Installation of replacement 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
Owner: FEES
DON MORISSETTE COMMUNITIES LLC
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 7/15/2005 $36.25
[TAX] 8% State Surcha 7/15/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone : 503- 692 -5945
Reg #: L1C 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: y Q� �1 ��
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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Building Fixtures •
Plumbing Permit Ap_pl'ica " "tioll>�� ® FOR OFFICE USE ONLY
il titom,' 't
Cify of Tigard R_ _ 'f
Date/By / Permit NIi. 1 tn ab 1/70, /
13125 SW Hall Blvd., Tigard, OR 97223 l `
Phone: 503.639.4171 Fax: 503.598.1960) I J! b 2005 ! a Plan Review
q tr,.. ,\ Other Permit No..
24- Hour Inspection Line: 503.639.4175 - � .r"4 iii Dale/By:
Internet: www.ci.tigard.or.us CITY OF TIGAR' -,-, l _ Date Ready/By: 7 °' 1 ® See Page 2 for
Notifed/Method: / ('�' Supplemental Information
TyWElIUFiwO 'omit y FEE* SCHEDULE
New construction ❑ checklist. Demolition For special information use checklis {
Description I Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2 - family dwellings (includes t00 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath I 249.20 1
�1- and 2- family dwelling E] Commercial/industrial SFR (2) bath f 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder 111 Other: Each additional bath kitchen 45.00
Fire sprinkler ( sq. ft) Page 2 I
JOB. SITE INFORMATION AND LOCATION' Site utilities
Job site address: / . 7 c p., ) 6.,-,-,,, - 1 4 7 Q DA- Catch basin or area drain 16.60
City/ State/ZIP: % (pa /t(� t� 9 7 1. L L/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: !! Project namtc(,(,m L� a C''� 0 Footing drain (no, linear ft.: ) j Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
S "L.L 6e_ Cf A art C( 14..0 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisio ,rn rvk. (Li--. �tLGq _ I Lot no.: O Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: L S Fixture or ite
i
Absorption valve 16.60
DESCRFP CON OF WORK.
c Backflow preventer 1 Page 2 .D7 S
. 5
.trG, Se" ace, ! r:�'/ C r!� ! f/1 tLiCLCl`� / t (q j /, ; ,. e si Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. PROPERTY, (WNER .
, . .j . Drinlong fountain 16.60
❑ T
Ejectors /sump 16.60
Name: b n / ten fJ'y S s r •, * 1-f ✓'-y ) e ,, Expansion tank 1 6.60
Address: L-f C 3 L S Lt .t (>tc„ ( CC) 0 OCt. Fixture/sewer cap 16.60
City /State/ZIP: K C . � • i:v e <JCj U/2 e l 73.3 S Floor drain/floor sinlc/hub 16,60
Phone: ( ) ` Fax: ( ) Garbage disposal 16.60
APPLICANT - 'CONTACT PERSON Hose bib 16.60
f �. , ^ /, Ice maker 16 60
Business name:
��Ca..f i /- .� _ Ct ,�: t . G'F L% L, Interceptor /grease trap 1 6.60
Contact name: ell fir\ _ CV -tits Medical gas (value: $ ) Page 2
Address: i 9' -1 f (. (j) l Primer 16.60
City / State/ZIP: /,t (i_ �c -L, 2. , j -7 /vi (' ,Z Roof drain (commercial) 16.60
Phone: (50.3) /..G.' 9.-: -J� (/5 Fax: : (.S ' �, y,q - 0'i -, ,Si Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60 ,
Business name:[ IS(, .eJ L Orr -f/e:./71 Z : r. r Water heater 16.60
Address: 7 -x-00 S to ip 1.4..S101.1-1 j2 Other:
City/State/ZIP:7n JG.� '470t'a :::e.- Subtotal
Minimum permit fee: $72.50
Phone: 6 (pQa _S Fax: 6 ( - 070,g' Residential backflow minimum permit fee: $36.25 2 •
CCB Lic.: goy Plumbing Lic. no.:
Plan review (25% of permit fee)
a D 0 - 7 State surcharge (8% of permit fee) , l 'b
A
I
uthorized si
� Lt j ..4t .1/�a... ' TOTAL PERMIT FEE 1 9 , [ S
Print n % / e �, 'Z Dat 'I 3 1 0 S This permit application expires if a permit is not obtained within
�"J 180 days after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Boa.d.
■'\ Building \Pemats \PLMF- PermilApp.e.e I2/03 440- 4616T(10 /02/COiM/WEI)
2 ' d 89L0- 269 -EOS U i 9 I 13 e . i =8D SO S I m nr
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00319
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/150005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: i121/200 TIME: 7 PAGE: 84
SITE ADDRESS: 15187 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 001 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of replacement backflow device.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503.387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.692 -5945
Inspection Request Scheduled For: Date: 7/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011830 503.692 -5945 N
Corrections / Comments /Instructions:
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1 ] PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: 1 77 '1i Date: / Phone #: (503) 718-