Permit CITY TIGARD PLUMBING PERMIT
,'�.i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00677
��111 DATE ISSUED: 12/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -05500
SITE ADDRESS: 15186 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 032 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 GALEWOOD ST. STE. 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 12/7/2005 $36.25
[TAX] 8% State Surcha 12/7/2005 $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: s .„ 7 Permittee Signature: . P ' C1 �Q�(7
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. 1 e
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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(City of Tigard DE C 0 2005 DatelBY: a 7 - 0 *5 -9�- e ``� 1 V v`.�K - daC / /
y Permit N .:'
13125 SW Hall IIlvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 474t14.41114 Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 CITY OF TIGP Y
�"` "• � Date Read /B J°t Q a see Page 2. for
lnternot: www.ci.tigard.or.us " `-- l� '�
BUILDING DIV'alv Notified/Method: I-1W S u pplemental Information
1 TYPF. OF WORK `rEE* SCIIEDULE
t LN New construction ❑ Demolition For special information use checlttist.
Description .1 Qty. J Ea. 1 Total
❑ Addition/alteration/replacement p Other: - -- 1 New 1 -2 family dwellings (includes 100 ft. for each utility connection)
I CATEGOR s' OF CONSTRUCTION N I i SFR (1) bath 249.20
- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath
SFR (3) bath
350.00
❑ Accessory building
III
399,00
Each additional bath/kitchen 45.00
❑ Master builder CI Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION _ Site utilities
Job site address: / $T/ rt.,- S.L.( G,--e(/1 fi C.1 L Qt Catch basin or area drain 16.60
City/State/ZIP: TI if 1("(e L OP--• 7 7 a-0 f Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Proje.6.10.4Wn WIL /-- R- et/.e, 3;1-- Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 1 10.00
Cross street/directions to job site:
�+ Manholes 16.60
1-
-(2 • a e e &L- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ______) Page 2
^, Storm sewer (no. linear ft.: ) f, Page 2
Subdivision iyh )Y1 £i-- / t L C / - t , Lot no,3 Water service (no. linear ft.: ) Page 2
--
Fixture or item
Tax map /parcel nol(+ 5:5
Absorption valve 16.60
DESCRIPTION OF WORK - Backflow preventer 1 Page 2 0•9 .SS'
l +i; - • .S l' -&A'. 1srr (1(2...t (. ✓1 �-
�'' 7.
7 / :7 7 (--/0-L,0 G%(.9)./e_f Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
- - - - nn fountain D king f 16.60 •
PROPER'FY. • • • ❑ `TENANT • . • .
• Ejectors/sump 16.60
Name: b G y1 f'Y) i, S i` '' H C' J Expansion tank 16.60
Address: y 3 G' . 6 e -Z -E) C i 0 e Fixture/sewer cap 16.60
City/State/ZIP: Lcm .k C C.) 1 ii; e < C ,o,_ % Lam, -j S Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: ( ) Fax: ( ) -
PPLICANT Hose bib 16.60
A
'El PERSON
- -- •- - Ice maker 1 6.60
I Business name: /1;. p'C% .; f -L•/ , 0.C`, C'K . / -'.
. n >'? Interceptor /grease trap I 1 6.60
Contact name: ' ,.,, 0 d t r, C- Medical gas (value: $ ) Page 2
Address: ( D-0 0 . - L) t`"1 t.,•I' � - 1 L /1 t. D Primer 16.60 1
City/State/ZIP: i • . J 47 ' L Roof drain (commercial) 16.60
Phone: SU. C : - S �' Fax; : r / Sink/basin/lavatory 16.60
o,- Tub /shower /shower pan 16.60
E -mail:
-_ _ -_ -- - ._--- __ - -._ .. Urinal 16.60
. . CONTRACTOR Water closet 16.60
Business name: / I Sin f..� O; .r.L /(f-, ,� r Water heater 16.60
Address: /' ,? -a -Oc S /.i`.�) /'trl L',g. -C " !..-' . Other:
City/State/ZIP: spy `�O .�-. Subtotal
Ty /State/ZIP: 0 ' 6- 2P d �06, Minimum permit fee: $72.50
Phone: 3) i t . y
C Fax: S( :3) C� 1.J 0 Residential backflow minimum permit fee: $36.25 ��
Plan review (25% of permit fee)
CCB Lie.: /U Plumbing Lie, no.: �
A State surcharge ( of permit frel �, Z D
Authorized signahf / /� 1 i � �+)
/ /iti L -. c • 1 � />.�U1 i TOTAL PERMIT FEE I 3�/.l • .S
Print name 1 -6,.,:l -6,.,:l � { - ^ Ti + ; ; Dat/ 0 '7 I (& S 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:\ SuildingtPurmits\PLMF- PermitApp do, 12/03 110- 161'T(10 /02
Z' d 99L0- Z69 -EOS uaii3 e90 :0T SO LO °all
CITY OFTIGARD. :.
BUILDING DIVISION A PERMIT #: PLM20000677
13125 SW Hall Blvd., Tigard, OR 97223 • c�5to DATE ISSUED: 1217/2005
Phone: (503) 639 -4171 ���
Inspection Requests (24 Hrs.): (503)• 639 -4175 " `: -41
INSPECTION WORKSHEET FOR DATE: 12/2112005 • TIME: 7:01AM PAGE: 3
SITE ADDRESS: 15186 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 032 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: bacl- iow preventer for irr gatk;r' '
OWNER: DON MORISSL.I I E COMMUNITIES, LLC, • PHONE #: 503 - 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC: PHONE #: 503
Inspection Request Scheduled For: Date: 12121/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 023866-01 503-692-5945 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL CALL FOR I SPECTION I ADDITIONAL FEES ASSESSED
4
Inspector: Date: +' - Phone #: (503) 718