Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES
PE
DEVELOPMENT PLM2005 - 00674
a�� I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/7/2005
PARCEL: 2S 109DA -06400
SITE ADDRESS: 14998 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 041 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 12/7/2005 $36.25
[TAX] 8% State Surcha 12/7/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
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: 747 \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.
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13125 SW Hall Blvd., T OR 97223 t1✓* s 1 !/( '
Phone: 503.639.4171 Fax: 503.598.1960 N R Pla Review
(° " Rece vt ed y : � t -hr J 41 r Date/By:
24 - Other Permit No.:
4- Hour Inspection Line: 503.639.4175 IS) M i a'+4 .t/ _; Dace Read /B laris '
Internet: www.ci.tigard.or.us `- """' Ready /By: ' 0 Supplemental '
' ` Notifted/Methoe: / I Supplemental Lrrurmanun
TYPE: OF WORK6,�'(ii\�(�j IEEE" SCHEDULE
ew construction ❑) lo1uion For special information use checklist.
i - Description J Qty. I Ea. 1 Total
�� Addition/alteration/replaeement ❑Other: `- -, New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath I 249.20 !
\q and 2- family dwelling El Commercial/industrial . SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/Icitchen 45.00
❑ Master builder ❑ Other:
- -- Fire sprinkler ( sq. ft) I Page 2
JOB: STFE INFORMATION, AND •LOCATION Site utilities
Job site address: /Y q qe ,ct i c7 I- C ,( cZ /D Catch basin or area drain 16.60
City/State/ZIP: 77 1 a /Le 6 R._ 9 -/ d- 0- L Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project nary J k31 InLi.- i4..9- � T/
Manufactured home utilities Footing drain (no. linear ft.: ) I Page 2
110.00
Cross street /directions to job site:
Manholes 16,60
/ae -'7C lat-iltL. R..Q Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision.S�l,(M1'V�.L ' ,QLal 9e Lot no.: L/ ! Water service (no. linear ft. ) Page 2
/_ / Fixture or item
Tax map /parcel no.: S � 5s. -/4 7
Absorption valve 16.60
I)ESCl2 PTION OF WORK Backflow preventer / Page 2 _7, 5.
, 6 .,(`. G49! , , ii -- r i C,t�Fsf (_iy'i ho...c /q' j'(hcc) l ) /�.('. Backwater valve 16.60 '
Clothes washer 16.60
Dishwasher 16.60
:: : PROPER•I"Y..:rOVV!' ER •
❑ TEN ANT. i
Drinking fountain 16.60
Ejectors sump 16.60
Name: b 6 /Y)(» - i s •-r; ` - / v! ea Expansion tank 16.60
Address: !- 3 L. . `:L 6w'_/ e. _.to 6; ocL Fixture/sewer cap 16.60
City/State /ZIP:L. ..%Z L, C;) , 1 e.7 C/ C/ / '7 (.: . 5 Floor drain/floor sinlc/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
APPLICANT
EI CONTACT 'PERSON
Business name: Lo.,vi /( ; 7:0 . . 0 _,,, ..,.,•'i?-. i ,•-v ^ /- -' Ice maker 16.60
` �f ' Interceptor /grease trap 16.60
Contact name: ) ,r, 4
Medical gas (value: $ ) Page 2
Address: , ---O •:-a) on /L�s;-fT'.tL ilZ Primer 16.60
City/State /ZIP: j- t /i (� ' i• IY- (.4:. ' 7j , r,i� ce+ Roof drain (commercial) 16.60
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Phone: (,j0. �) (G 9.:-.? -.S F ax:: Sink/basin /lavatory 16.60
(S 3) ' _ - C'"16.1 �:,
E -mail:
Tub /shower /shower pan 16.60
-- -- Urinal
- -- 1 6.60
CONTRACTOR -- Water closet 16.60
Business name:l 4lS(;.. J). O L;u -i -;i�/--) v Water heater 16.60 I
Address: / Z.D. -00 .S / i) : M L r !by �/ O 1rj Other:
City / State/ZIP: 1.1-E�.eq- a'��r "10/-2.,„. ` .. .70 ` - Subtotal
_ Minimum permit fee: $72.50
Phone: r(J�) �� C.T9 ) aa:"' Fax: C''.:7 �7 . ) / 07( Residential bacicflow minimum permit fee: $36.25 36) , .,)
CCB Lie.: / JUL Plumbing Lie. no.: Plan review (25% of permit fee)
//_ /; ' `A State sttr:harEr (854 of nrtmit fer.) 0
Authorized signs , ;° �j .f ,�j� ii 1
p
r' '' ` , �� ` y_`
TOTAL PERMIT FEE • L
e_ _ ^" r
Print name• / o `7/ .$ permit application expires permit not / 6
• 4r- -' �/ �� ���r; v'�!:. "� �'� ��• °. DaCj � Th is ermit a lication ex tres if a ermit is no. obtained s thin
180 days after it has been accepted as complete.
- Fee methodology set by Tri -County Building Industry Service Board
1 :\ BuildingiPennits\PLMF- PerntitApp dac 12/03 440-4,116T( 10/02/CO Wwl:B)
a'd 139L0- x69 -EOS u ait 3 eSj. =60 SO LO aaQ
CITY OF TIGARD ...
BUILDING DIVISION PERMIT #: PI 2065-00674
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: J712006
Phone: (503) 639 -4171 i n At m ll llt� 3�
Inspection Requests (24 Hrs.): (503) 639- 4175±+� �! -
INSPECTION WORKSHEET FOR DATE: 1/ I7720f16 TIME: 7:05AM PAGE: 2
SITE ADDRESS: 14998 SW CREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 041 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Bacidlow preventer for irrigation.
OWNER: DON MORISSE TE COMMUNITIES LLC, PHONE #: 603 387 - 7538
CONTRACTOR: LANDSCAPE OREGON, INC PHONE #: 603.697 -5945
Inspection Request Scheduled For: Date 1/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 025090 -01 503.692 -5945 N
Corrections /Comments /Instructions:
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•
PASS ARTIAL APPROVAL ❑ CANCEL ' OACCESS
❑ ° IL C ' FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector. 4 — Date: �' P one #: (503) 718 -