Permit ,
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -10009
DATE ISSUED: 3/2/2006
L 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 109 DA -06300
SITE ADDRESS: 15032 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 040 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 SW GALEWOOD ST. STE. 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 3/31/2006 $36.25
[TAX] 8% State Surcha 3/31/2006 $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: � (� �/'1i� Permittee Signature: 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.
. r'ECE VED
Building Fixtures V _ ,1 L' tn?-
Plumbing Permit Application � FOR OFFICE USE ONLY • .
UI I Y OF TIGARri Received
C1 2 5SW Ba Tigard, OR 97223 BUILDING DIVI�tOe4 "
Date/By: Permit N .: oZOd G " l
s o2 () 'per \��/0 9
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960a rp�in r +i� D ate/8yc Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ■ A I Jar s;
Internet: www.ci.tigard.or.us ^'� ` --+ Date Re Notifiedi/MethoMctho 0 See Page 2 for
d: 1 I it Supplemental Information
- . - p
'F C
N New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
El Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
• rl: ,t ;-, '!CATEG'OIRY `Q'F`'IGOiS'T LC'.FION 1•!,• SFR (1) bath 249.20
and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
El Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/lcitchen 45 00
•
❑ Master budder ❑ Other:
T
Fire sprinider ( sq. ft.) Page 2
g ,�:, ti , N _ .
q1 'JOB 'S1T E=; 1NIFOIt)VIi4T ON' ,ytIC ,* - "!:.'
- - � r.rj�:ah'�, :.
. .Y,,,..,,,n.., •....:. ..1:(?!�j - ,�,: .:,.;> .. - , . Site utilities
Job site address: 16 03e . S U) Grr c.,- e eta._ Die_ Catch basin or area drain 16.60
City/State/ZIP: 7- q e tcL_ Q, q 7 a.. y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project naStthel rn G -, tat et q qO [ Footing drain (no. linear ft.: ) Page 2
l R Manufactured home utilities 1 10.00
Cross street/directions to job site:
Manholes 16.60
S u) I. e. cc- (3 e_rt ct- /2_12_ Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: S I J.j 1'I (Y1 t f' - g . - 1 Lot no.: (-t• [ j Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: 62 s 5 - Fixture or item
Absorption valve 16.60
I •'- DESCRIPT :OF ; W .- t i. i - ',i -
LL ,, G :, ... ........ .. ,. .. �-. •:r,:1: ` . .... v.". .. B ac kfl ow preven / Page 2 a-�. SS
.,)C -,_cc a pity • i rri 0 (� / ! . r,-, / 1 ,��-G{� / 04 < :, ,, C. - Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 16.60
Drinking ountatn
... .. D king f 16.60
. iP1iioi'l iii i �.,; . icokit •' ' :y ';: , ti d *EN A147' ' ..
�K;.... ;'.... >rp s.. , •. tu ... _. I, ". : Ejectors /sump 16.60
Name: b C:-' - n - ) / 5 l i / _ S (-_-.24.-,' / -i Y)1 e__:_ Expansion tank 16.60
Address: z---/„ 3 (..-, j LL+ 6.-.->z ( e E 0 C t cL Fixture /sewer cap 16.60
City/State/ZIP:LIi k r ✓ • O.O i_ L I << %L (I . '7 % (2.._1,. `- Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 �
_ ,: it;;• „ : 1 ; t, �; r :. Hose bib 16.60
'y: `f • '� ":tYPPJ TCie fl'i�'`� < 1 e(t T A6')E:: l'ERSO ; '
• ...;:...• . ' : ., � " Ice tnaker , 16.60
Business name: t L ' ' v' .-ef0 i <_-_,
��C .T' /. , �G /_G f / /:? 1 T / Interceptor /grease trap 16.60
f
Contact name: 7 ,'f 01 ...Sp f './ •:% / r L( i Medical gas (value: $ ) Page 2
Address: 1 9 .� (.) 0 • LL) rrI 1 j Si l v`t t-1 RD Primer 16.60
Ci / State/ZIP: J / , 6_7: , l Roof drain (commercial) 16 •
�_ Sink/basin /lavatory 16.60
Phone: (S6 3) (G /`� - S/y;3• Fax:: (� �•='.3) &- C,' -A'
- Tub /shower /shower pan 16.60
E -m ail: Urinal i 16.60
`•r' . - ` :. COIV,TR)iCT.O*: .4: ",'. Water closet 16.
Business name: / L ,- ,_, _•, n fj. / ;; . -( . T.:/- - , r Water heater . 16.60
Address: / 3 C)C i 1 t , r, ; y �. K (� Other:
City/State /ZIP: '�/tL(,jj. -7n )i2 7L)(" Subtotal
I "` Minimum permit fec: 572.50
64,
Phone: 3) lcQ 5 / S Fax: 5 C ,9 - or-70 g' Residential bacicflow minimum permit fee: 536.25 3(p.. S
CCB Lie.: 7 e(.1.) P lumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) v
Authorized signs 2,1,_ ( /,
c � 4_ ,..4_,...e TOTAL PERMIT FEE 39 , t S
Print name - el) „c- 62/---rLI•uJ DaP - 3 /Q{P This permit application expires if a permit is not obtained „ ithin
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i .',RuildingtPcrmits \PLMF.Permit A pp. (IOC 12'03 440- 4616T(10 /02/COM/WEE)
E'd 89LO- 269 -EOS u d :E0 90 TO JeW
CITY OF TIGARD 3/31/2006
l ik i
' ' 13125 SW Hall Blvd.
° Tigard, Oregon 97223 • 3:09:SOPM
TIGARD (503) 639 -4171
■
Receipt #: 27200600000000001043
Date: 03/31/2006
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
PLM2006 -10009 [PLUMB] Permit Fee 245- 0000 - 431000 36.25
PLM2006 -10009 [TAX] 8% State Surcharge 100 - 0000 - 207020 2.90
PLM2006 -10010 [PLUMB] Permit Fee 245- 0000 - 431000 36.25
PLM2006 -10010 [TAX] 8% State Surcharge 100- 0000 - 207020 2.90
Line Item Total: $78.30
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard LANDSCAPE OREGON DER/DLH 096519 In Person 39.15
CreditCard LANDSCAPE OREGON DER/DLH 096519 In Person 39.15
Payment Total: $78.30
cReccipt.rpt Page 1 of 1
V.
....
CITY OF TIGARD
DEVELOPMENT SERVICES
RECEIPT
RECEIPT DATE: 3:;2
,,Aztoopp 13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.: 1 - ) L
.4.4114;r1L. : 503-639-4171 www.tigard-or.gov CASHIER DATE:
CASHIER RECEIPT #:
LINE ITEMS:
Case No. Fee Description Revenue Acct. No. 1 Amount Due
,,
. \ - - "S - S)y ;?-- 50
i
Total Due: $ - n,3'4O
CI SEE ATTACHED FEE SCHEDULE.
PAYMENTS:
Payer: '
Method I Initials I Check No. 1 Confirm No. ' Amount Paid
i
C.c.--e. ACy cc),- d.,___I -- - -- -- L f.;7„
C ‘c•-..? c A, , ,l•- - C._ T.-Lk.1
1 .
Total Paid: $ - 77'',, 3 !:-)
It\BuildingTorms\ManualPermitForms\ManualReceipt.doe 03/01/063/1/2006
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 006 C�
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ice i,
Inspection Requests (24 Hrs.): (503) 639 -4175 ��&W _ :_..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / J 3� CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: . . _ .
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 - /5 0' Pour Time:
Code # Inspection Description Confirm # Contact # • Message
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL Il NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: hii 1�`f�. -.� Date: I �f 0 Ci Phone #: (503) 718-