Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PL /5/200 -00668
c 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/5/2005
PARCEL: 2S 109DA -07000
SITE ADDRESS: 15119 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 047 JURISDICTION: TIG
Project Description: Backflow preverter 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 Description Date Amount
4230 GALEWOOD ST. STE.100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 12/5/2005 $36.25
[TAX] 8% State Surchan 12/5/2005 $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 503-246-6699 or 1- 800 - 332 -2344.
Issued By: c� /�� Permittee Signature: i7/ d,p 4 -aJ ;
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.
F1 , I :Unldhug'Fixtures
Plumbing Permit AlpPIRCwttOTc c FOR OFFICE USE ONLY
City Of Tigard Received
13125 SW Hall Blvd., Tigard, OR 97223 r Date,l3y: 5? 06 a, Permit N� �2�� --0e)6,45,/ �EC . t1f��
Phone: 503.639.4171 Fax: 503.598.1960 l t� Date/By: Permit
24 Hour Inspection Line: 503.639.4175 r .�. �l Plan Review
Ob P it N
Date Ready/
�'
Internet: www.ci.tigard.or.us " "= A . �W- y ' 1� See eni i for
CITY OF TinARn NatinedtMethod: Supplemental L,fur cno li o n
j TYPE OF Mio:IU ING DIVISION I'f.E' SCI IFDC LE
N ���T TTT New construction ❑ Demolition j For special information use checklist.
l Description I Qty. I Ea. Total
El Addition/alteration/replacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUC'T'ION I SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath /kitchen 45.00
Fire sprinkler ( sq. ft) I Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I S [ 19 .S 4) &re Ln c e lC{ DA_ Catch basin or area drain 16.60
City/State /ZIP: 7 l L1 . f a /- O IQ- y 7 a D- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: [ Project n g , i bi le-LGI�f LI -) Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
/ � Manholes 16.60
.� U' I, LA, � '‘,,-4 /4_1-D Rain drain connector j 16.60
Sanitary sewer (no. linear ft.: ) Page 2 I
Storm sewer (no. linear ft.: Page 2
SubdivisioQL,Lni, 1, f �r Q 9 Lot no.: y
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: e...0 ..
9 Fixture or item
Absorption valve 16.60
DESCKITION OF WORK Backflow preventer ! Page 2 0-7 - s S
/ Cam'-; *'ice! • -h /` (2_,(:),-, (1 / t/%J._f' !;:/l :7( /.i /s`' /f i, _i „ / „ _ i Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER Drinking fountain 16.60
®
❑ TENANT
- -- Ejectors /sump 16.60
Name: J 03i r/,' 4: S • -S f 7L ;- j ,1 � c,
Expansion tank 16.60
Address: �Q 3 L. L-�, G - � . - % .`. L CC t Fixture/sewer cap 16.60
City/State/ZIP:% 1- f :L (. i., :;_,1 C y t C. = ice- /' /Cam,-; fi:, Floor drain/floor sink/hub , 16.60
Phone: ( ) F ax: ( ) Garbage disposal I 16.60
•'Q APPLICANT 1=I `• Hose bib 16.60 CONTACT PERSON
Ice maker 16.60
Business name: r I nterceptor /grease trap 16.60
Contact name: '' i Ni') O;- .!--(;-,/,_:. Medical gas (value: S ) Page 2
Address: i ' C'/ / (' L). d
" ,i' 't �1 Primer 16.60
City/State/ZIP: ; }� 9 /1.: 1 %V-yk_ , J 7 - 26;• l �_ Roof drain (commercial) 16.60
i, ) (L q..1. _� % - (-1 s l ( j e.:j) , t - �,, :, Sink/basin/lavatory 16.60
Phone:
(JL 3 Fax: /, _ C i
Tub /shower /shower pan 16.60 i
E -mail:
- - _..... Unnal 16.60
CONTRACTOR Water closet 16.60
Business name:,/ (; c1 S (' i'd�J <, �); %`�j /)i / ij C Water heater 16.60
Address: / ;� ,S ;-0C. /,;,) 'sr, f 2 / /1...c...! Other: .
+ _ Subtota
City/State/ZIP: 7"/ " /f? -
h L��£ uE"a, his ���:�
Minimum permit fee: $72.50
Phone: (t ) f. r) c -c1,1--P--- Fax: (5:03) (, ., i' cQ 0 t (, g' Residential bacicflow minimum permit fee: $36.25 3(c - o. S
CCB Lie.: y Plan revie (25% o permit fe
S� Plumbing Lic. no.:
f g State s (53 of hermit feel - f )
Au sign L D ~" I` '
'. i_ � , i•- 1 .. =�,../ I TOTAL PERMIT FEE 1,3 y , /S
Print name; : -= • 4/ ,& ) ..,,S,:,/,';62.,_:',Y-1-:-..,,i;_.)."
-'
I Dat jy- 0 2 -0 S I This permit application expires if a permit is not obtained '••id,in
180 days after it has been accepted as complete.
`Fee methodology set by Tri -County Building Industry Service Board.
i:\ BuitdinC \Permits PemutApp.doc '.2/03 440- 4616'r(!G /02 /COM /WEB)
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00668 i
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /215/2005
Phone: (503) 639 -4171 � jui Inspection Requests (24 Hrs.): (503) 639 - 4175' I ..
INSPECTION WORKSHEET FOR DATE: 12/6/20 TIME: 7:02AM PAGE: f3
SITE ADDRESS: 15119 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 017 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflowa preverter for irrigation.
OWNER: DON MORISSETTE COMMUNITIES, PHONE #: 503-387-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.692 -5945
Inspection Request Scheduled For: Date: /2/612005 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
399 Plumbing final 023016 -02 503 - 692 -5945 N
Corrections/Comments/Instructions:
1— Q---S" {- (74_ 5 5.--i
0 .---
c...) . e...-5,, ,...
Y(1) .
0 74 - §s 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED •
Inspector: H/\ t/ Z-- Date: 1 2- / e.o O- \ Phone #: (503) 718-