Permit ' e
CITY TIGARD PLUMBING PERMIT
.I'� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00277
- I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/21/2005
PARCEL: 2S 109 DA -02500
SITE ADDRESS: 15199 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 002 JURISDICTION: TIG
Project Description: Irrigation backflow preventer.
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 HOMES Description Date Amount
4230 GALEWOOD ST
STE 100 [PLUMB] Permit Fee 6/21/2005 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 6/21/2005 $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 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 - 246 -6.99 or 1-800-332-2344. ■
Issued By: �` �� 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.
A lluding r tii; „� Fixtures '
r ' E _ E1VE (-
PIumbin Permit Application70
City of Tigard JUN [110 FOR 'OFFICE USE ONLY - • '
13125 SW Hall Blvd., Tigard, OR 97223 Receiv Da 6
Review
� Permit NI) Phone: 503.639.4171 Fax: 5 03.598�h9ToY OF TIGARD / Plan n Rev Revie I '� 7
24 - Hour Inspection Line: 503.639.4 ULDING DIVISION �L�l I A Da y Other Permit No.
Internet: www.ci.tigard.or.us . ^ti2' ��'! Date/By:
Ready /By:
Notified/Method: MI El See Page 2 for
TYPE OF �VOI2K Supplemental Information
au New construction FEE* SCHEDULE
❑ Demolition For special information use checklist.
❑ Addition/alteration/replacement Descri.tion
❑ Other: Q . Ea. Total
CATEGORY OF New 1 - 2 family dwellings (includes 100 ft. for each utility connection)
IN CONSTRUCTION SFR (I) bath
1- and 2- family dwelling 249.20
❑ Commercial/industrial SFR (2) bath
❑ Accessory building 350.00
❑ Multi - family SFR (3) bath 399.00
Each additional bath kitchen 11111 45.00
❑Master builder ❑ Other:
J013 SITE :INFORMATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Job site address: / 57 L() C /�,�.t,Cs�) "5C fey( I
City/State/ZIP: TJ G 4(,At (;.L 0 ' L� Catchbasin drain 16.60 -
� G� ` :9-..,"1- :9-..,"1- � • - Drywall, leach ch line, or trench drain
Suite/bldg. /apt. no.: Project nam� � ci h 1 g Ii Jli (#- L t .6, C�,7.Z.� Footing drain (no, linear ft.: _� Page 2
e 2
Cross street/directions to job site: g
Manufactured home _
( 110.00
',w ' ome utilities De. t( 6.' Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear fl-: ____) i -
Subdivision: S l (yrn m / , ..e..,, Lot service (no. linear ft.: _ Page 2
) Pa
Lot no.:Q�, g
1 Tax map /parcel no.: s SS Fixture or item
DESCRIPTION OF WORK Absorption valve
16,60
,�_ (� S �- Backflow preventer / 37 ,
C a_) /r Yl��/17 /tea` /• ,� �7,s1 Page 2
/ � f - f � �'� -•- ..::,:it'-' / y Backwater valve _
16 -60
Clothes washer r 16.60 '
Dishwasher 16.60
PROPERTY OWNER Drinking fountain _
❑ TENANT 16.60
•
Name: b� !�3 )(3~�! S S :`_f_ 1 /�y Ejectors /sump 16.60
Address: z--/Q 3 G' S LL► Expansion tank
�l�(C� o�'�: 16.60
City/State/ZIP: (�i- j� C Fixture/sewer cap 16.60
S LU e< C1 0k. 7 l�.3 S Floor drain/floor sinic/hub _
16. 60
Phone: ( )
Fax: ( ) Garbage disposal
APPLICANT 16.60
CONTACT PERSON Dose bib 16.60 -
Ice maker
- /" / _f t �f
..: �}t� �: �'\ >�) 16.60
liusiness name: / , Ct
C ontact name: ..ii/ : Interceptor/grease trap 1 6.60
•
G� -da'd - tom,'
Address: 1 -3 pU Medical gas (value: $ ) _
jy
�ity/State /ZTP: 1 G le_ I� J Primer =
: '7L' - Roof drain (commercial) 16.60
-
C . i = ? - . S
'hone: (5 ,3) %yJ Fax:: c , u '.7.,.f..'
Sink/basin/lavatory
(� < 3) - C ry 16.60
mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
tusiness name: / Water closet 16.60
U �(r On'.L 0-2-1 ��,,-; Water heater _
.ddress: / -EGG ` / Li Joel l.„! gin Other: 16.60
iry /Sta e
te/ZIP:
G �
7
bone: te/ /� U ✓� Subtotal
�`aa Fax: 6.03) � e v r� Minimum permit fee: $72.50
CB Lic.: 7 �(� g Residential bacicflow minimum permit fee: $36.25 2( • -25�
_ Plumbing Lic. no.: Plan review (25% of permit fee)
7
uthorized signat a s
° Lt:�� .... „..4. J�J I State surcharge (8% of permit fee) ,., qD
int name` I TOTAL PERMIT FEE 1 39, ( S J
Dat'
c 9/ US This permit application expires if a permit is not obtained + +ithin
180 days after it has been accepted as complete.
u ilding\PcmutslpLMF- pcmil[App doe 12/03 *Fee methodology set by Tri -County Building Industry Service Board.
440- 4616 T(10/02/COM/WEt))
a'd B9L0 -ZG9 -605 ua i i3 eBZ:LO SO 'Ea OTC
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00277
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/21 /2005
Phone: (503) 639 -4171 : 4 27 , 44mi",l l l
Inspection Requests (24 Hrs.): (503) 639 -4175 J ..
INSPECTION WORKSHEET FOR DATE: 7/12/2005 TIME: 7:06AM PAGE: 68
SITE ADDRESS: 15199 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 002 . TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Irrigation backflow preventer.
OWNER: DON MORISSETTE HOMES, PHONE #: 503
CONTRACTOR: (LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
Inspection Request Scheduled For: Date: 7/12/2005 Y. Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011192.02 503.692 -5945 N
Corrections /Comments /Instructions:
s i■-••■t f ,/Aled _ A Af z
r
•
- 0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
�-
'9(� FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: )' 4 6, 1 Phone #: (503) 718-