Permit - CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00105
°ell 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/17/2005
PARCEL: 2S1 09 DA -S R045
SITE ADDRESS: 15067 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 045 JURISDICTION: TIG
Project Description: Irrigation backflow
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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 MORRISSETTE COMMUNITIES Description Date Amount
4230 GALEWOOD ST # 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 3/17/2005 $36.25
[TAX] 8% State Surcharp 3/17/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLON RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97066 2
Phone : 503- 692 -5945
Reg #: LIC 7804
PLM ALL PHASE & BA(
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 503-2469 o71- 800 - 332 -234 .
Issued By: ( � , p r'l Permittee Signature: 6 G � C ez - T Z -
� U
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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id °I
Iitkil cling Fixtures inCrEk\ ED .
Plumbing Permit Apo lieatio i FOR OFFICE USE ONLY , • .
City of Tigard 0, 1 7.V.11 aemivetz ..
Date/13yiii / / 05 .6Ll Permit flo.
13125 SW Hall Blvd., Tigard, OR 97223
i RD. - Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 ,,, 0 -r, zr„., VN,o:S.i(li Date/y: Other Permit No.:
24- Flour Inspection Line: 503.639.4175 c a I ,.... ;L:4 ii Date Ready/By: 1 ' 63 ' Pi See Page 2 for
Internet: www.ci.tigard.or.us at 111...DMG Notified/Method: Supplemental Information
' 1W010::S '':.: ;.: :...::-. --..'' . ;. • .'--.....:': .,' ......t?E`'-§C1106ti'' .....".".. .- . '
For special information use checklist-
NNew construction 0 Demolition
Description 1 Qty. I Ea. I Total
0 Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
. - .-..- . ..
• .:'-',;•.-• . = ...: '. '..' ::. :Z.: .„,..,:CAT,F , . -..,.„.,•,,.. : j .•• ; • SFR (1) bath
1 249.20
b and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
_ SFR (3) bath 399.00 _.
0 Accessory building 0 Multi-family
- Each additional batMcitchen 45.00
{ 0 Master builder .0 Other:
,,. Fire sprinkler ( sq. ft.) Page 2
1
;.: .': -: -*- :-.-,‘::-. . Site utilities ,
Job site address: / S15 & 1 L!"7"--r e.4 f r / • () e_, Catch basin or area drain 16.60
City/State/ZIP: 77 y a.- CC. 0 X- 97 ,,--;_• 4--// Drywell, leach line. or trench drain 16.60
Footing drain (no. linear ft.: _) Page 2
Suite/bIdgJapt. no.: I Project name: Surni-n 1 RA ei .6 LI s .
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
S .1 - 1) 8cci 8 e.ii /. 0 Rain drain connector 1 16.60
Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft.: ______) Page 2
Water service (no. linear ft.: ) _ Page 2
Subdivision: S Lt nt) L_/-- jei d 7e i Lot no.: 1--/ C
Fixture or item
Tax map/parcel no.: Lci gS / 7 Absorption valve 16.60
••• - i . . .':: :: . '--..., 2 : . DES:C ;C . ;;':''= ',.: : . '': l;i! - ' ,: ...; :; Backflow preventer / . Page 2 3(
1--c■--64 -c(L etp(-: 2 rr; q 0-17 0 ho..eic' i i liu3 ,..- i c_,- Backwater valve 16.60
Clothes washer 16 60
Dishwasher 16.60
..,-. ... .,.. • ... .. - ---- .-- • -- Drinking fountain 16.60
..... .:•••''...'"::-.-pli"O:RE'ittl:*:,t();WNE*.:::..!;,.:•'.:::.:;•ril'i-..i: -, . 7 :g . ZIP-,0: ':;;:,.:- ,, 16.60
Name: bo-A rnt-ri s s t F/ C. -S . Expansion tank 16.60
Address: 2 :--/,,1 3 c.) S Li...) 6-z-,_.e e_ c.f.: 0 oet. Fixture/sewer cap 16.60
City/StaterLIP:LCL g c 0 ..0 LIJ -Cy() OR- '7 b3 3 Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: ( ) Fax: ( )
" .'':. • l':.NgtiiiPtiC44.;;":"'-1.-'!1efel:SfiaC'T''-'•i.SeiNA•• -'':l• Hose bib 16.60
16.60 ice maker
Business name: La as s- e 63/ ..--„ 2 6 i ..7. _T <1.." Interceptor/grease trap 16.60
Contact name: 1 --:- -- 77, 1 / ±..""^) „,..S f 6 Medical gas (value: $ ) Page 2
Address: / a-D-00 .S-L0 ry)Lf...c I imi (21) Primer 16.60
70 & ",)--- Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: („g6l3) 4e,...: (//,; - -....S Fax: :(5) 6 FcR - 6 ' '76:: .S
Tub/shower/shower pan 16.60
E-mail: . 16.60
. . ....
. ' • .. - .' .. • .• ' • " CONTRACTOR ..-... .. .,..--'' ; ' - ••• - . - ' '1 Water closet 16.60
Business name: tan (s ,, 0-7-K ,t.„„--.1c, Water heater I 16.60
Address: / ,S (0 i q...sicyl.L./ Ja.in Other:
Subtotal
City/State/ZIP: 7ULLIZ,L,12 1, ' `471)6, _.__ . Minimum permit fee: 572.50
Phone: (5/.... 3 ) toqa .... S,WS - Fax: 603) ( - Or7 OE' Residential backflow minimum permit fee: $36.25
CCB Lic.: 7 ev /1- Plumbing Lic. no.: Plan review (25% of permit fee)
. State surcharge (8% of permit fee) , L')
Authorized signs Lte j e,a,4_,,..4_,It.....0 TOTAL PERMIT FEE 39. / -
Print namell ef) „ct, afYO
e--C..C.) I DatS/[ I 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.
• - - . . ._.... .............„------
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00105
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/17/2006 Amnn�
Phone: (503) 639 -4171 ro uvil iilll
Inspection Requests (24 Hrs.): (503) 639 -41-75 ,..„—Al. 11..
INSPECTION WORKSHEET FOR DATE: 3/30/2005 TIME: 7:11AM PAGE: 45
SITE ADDRESS: 15067 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 045 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
•
DESCRIPTION: Irrigation backfluw
OWNER: DON MORRISSETTE COMMUNITIES, PHONE #:* 503 - 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692-5945
Inspection Request Scheduled For: Date: 3/30/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 003208-01 503 -692 -5945 N
Corrections /Comments /Instructions:
-),, f
w- ,:ori,
i
I ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,02 0 Date: .07 Phone #: (503) 718-