Permit , q .
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00236
AII 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2005
PARCEL: 2S 109DA -05900
SITE ADDRESS: 15124 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 036 JURISDICTION: TIG
Project Description: Irrigation backflow.
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 Description Date Amount
4230 GALEWOOD ST # 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 6/2/2005 $36.25
[TAX] 8% State Surcharl 6/2/2005 $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-•--s or 1- 800 - 332 -2344.
Issued By: dIP_ _ _ , � / _ Permittee Signature:
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 am required on the job site at the time of each inspection.
wilding Fixtures i);e /'h Srze0 5 - 0 0 0 /
Plumbing Permit Application cl VS . FOR OFFICE USE ONLY
City of Ti and 0 . 1 Received
13125 SW Hall Blvd., Tigard, OR 97223 �t -, Date/By: y: 9 a Permit No.: 44X05 - ODD S
Phone: 503.639.4171 Fax: 503.598.1960 Q j Plan Review
Other Permit No.:
r /r + ^� 41'�
Date/By:
24- Hour Inspection Line: 503.639.4175 C 1 t .C� y ; " .4 i1
r x
W Date Ready /By: a See Page 2 for
?MAIL Internet: www.ci.ti gard.or.us � Notified/Method: Supplemental information
TYPE OF VORK FEE" S EDULE
•
Flew construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. I Total
❑ Addition/alteration/replacement El Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 1::) Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Page 2
Fire sprinkler ( sq. ft.) g
•
JOB SITE INFORMATION AND LOCATION utilities
Job site address: 1 S7a..1-t 5 1JJ C-'fi'2 en - 6t1GC DR Catch basin or area drain 16.60
City/State/ZIP: r! 9 �� Q, - 7 t Dro 1, leach line, or trench drain 16.60
•
Suite/bldgiapt. no.: E Project nam rn c l- l � - Footing drain (no. linear ft.: - ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
, Manholes 16.60
S 1 p 'C e-`F � � � RD Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
• DESCRIPTION OF WORK Backflow preventer / Page 2 '2 7 . SS
/1_(..4.• tP;/1 . cc. /Zf.)f: / ' i f 0_ (Y' ,f /d..,fi f!`(}LC•1 , e. v; ,t.---
t.., Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
IS.L OWNER ‘ 0 TENANT
Ejectors/sump 16.60 `
Name: C?/ //) (_ ✓ S S r 7L + /-7%---.-)1 e Expansion tank 16.60
Address: L.-f 3C' s L.0 £ e-L (C -.C? 0 04=L_ Fixture/sewer cap 16.60
Ci /State/ZIP: 0 Li) e" C L. 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
'APPLICANT `[CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 111 -r/ Lf /1 e� - i, o E C Interceptor /grease trap 16.60 j
Contact narne: /-11 A'',..:/) S &ri U Medical gas (value: $ ) Page 2
Address: / d -OC) ( 1 rl'i Lt (4) Primer 16.60
1 1 Roof drain (commercial) 16.60
!
City/State/ZIP: (5 L ;3 Y:.�2 - 7c.�
) �'4(41 !)! c 0 ' 76' (L' „- - Sink/basin/lavatory 16.60
Phone: t !L'�1. - ,� % �/5 Fax: (S'3) CT!
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR Water closet 16.60 /•
Business name: Lans�,etp t, /� , T// � C, Water heater 16.60
Address: 7 �-�-r G ,S ) J;, ^, c_/ 1;.1 /';l/ V, Jlt� Othe
City/State/ZIP: '7 " �!'7O& ; - _ Subtotal _
7/� V Minimum permit fee: $72.50
Phone: 66) &Q,;, ,S'"S ' Fax: 5 5 �p9Q ° 0 70 gr Residentialbackflowminimumpermi tfee: S36.25 310 - �s
)3
CCH Lie.: 7 U y Plumbing Lic. no.: Plan review (25% of permit fee)
State 'y� �' cha � e f per _,,i i fee) 9v
Authorized signa ,!1 / , �.• (4� 0/ � o t-- ••��••
�L L / I " TOTAL PERMIT FEE 131, / S
Print name I Da / � ) S� This permit application expires if a permit is not obtained W ith
�� � �/ « 9 �� [[[ t 180 days after it has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board.
i:1 Building \Perrnits1PLMF- PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB)
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CITY OF TIGARD . '' (V
BUILDING DIVISION PERMIT #: PLM2006 -00236
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/212005
Phone: (503) 639 -4171 i °9��yp,ip�� IiI�I�
Inspection Requests (24 Hrs.): (503) 639 -4175 =� 9/
INSPECTION WORKSHEET FOR DATE: 6/9/2005 TIME: 7:09AM PAGE: 95
SITE ADDRESS: 15124 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 036 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: irrigation bacldlo v.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503. 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 692 - 6946
Inspection Request Scheduled For: Date: 6/9/20055 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow prey ter 008790-01 503-692-5945 N
30 6 ,sz
Corrections/Comments/Instructions:
T - ,L,,,-------
1
1 1\
1
_
. • .
■ '_ , _.
(. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \6 v V Date: V61/61S Phone #: (503) 718-