Permit CITY OF TIGARD
PLUMBING PERMIT
.,i DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00164
'I 13125 Al S Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/27/2005
PARCEL: 2S 109DA -05800
SITE ADDRESS: 15148 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 035 JURISDICTION: TIG
Project Description: Install residential backflow prevention device 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 Description Date Amount
4230 GALEWOOD ST # 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/27/2005 $36.25
[TAX] 8% State Surcharl 4/27/2005 $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
952-0001-88 I • rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
callin. .83-246-66°8 • 805
•
Issu-d By: .. ' j , i �L�G• _ . Permittee �i 7
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.
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E�tllIIIIIrgaiiia i[aerlIITllllit •\ 1 , au IlIl 'FOR' QFFIC .1.,•:.,t,,..-v.._ E' UNLv i17 LC+ , .. � }�. 3`
City off Tigard 2 05 Received ; J
13125 SW Hall Blvd., Tigard, OR 97R 2_ Plan Reviei / / Permit No.: ? r, ^ ^ -� l �Qi
Phone: 503.639.4171 Fax: 503.598.1960 b�x • b � t Date/By: Other Permit No.:
24- Hour Inspection TTT
ection Line: 503.639.4 w"' Rvi +, D Y:
p OF T 1G A � .�!t1 -z •W_ / '� _. Date Ready/By:
T RI Se Page 2 for
Internet: www.ci.tigard.or.us i g
C� ter Notified/Method: `!( Supplemental information
•
j1 Utt. t i ! t '! • L � l - FEE" SCHEDULE •
■ New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY • • • • SFR (1) bath 249.20
and u dwelling El Commercial/industrial SFR (2) bath 350.00
• SFR (3) bath 399.00
• Each additional bath/kitchen 45.00
■ • Other:
Fire sprinkler ( sq. ft.) Page 2
• :INFORMATION, t • t Site utilities •
.. site :,. /
Catch basin or area drain 16.60
City / State/ZIP: IT/ // C c ' .,1_a C2 A- ' l .=.2-9-fl C/ D_ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project namej(�[ iy) i RE«9, j - Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
Manholes 16.60
Beef 6 � RID d
ID Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
�n/L et (no. linear ft.:
Subdivision � � 9� J L no.�s Water service ( ) Page 2
Tax map /parcel no -: & C 5 Fixture or item
Absorption valve 16.60
' ` . • DESCRIPTION OF WORK
Backflow preventer / Page 2 ,Q . 7.
z - . • c - (2 , C I rr/ C 0:,/-7 ( f i n ' - fl ( ) z) / / ..; Backwater valve 16.60
1.
Clothes washer 16.60
Dishwasher 16.60
• • Drinking fountain 16.60
,. PROPERTY(: OWNER; El TENANT
- Ejectors/sump 16.60
Name:)Y'1 OrY/ S S • 7 /-/ - i e-S Expansion tank 16.60
Address: Z--t 3 0 S W (- ( 6;L -C, 0 Oct Fixture/sewer cap 16.60
City /State /ZIP: /C 0 G j e.. j 0, 74_3.3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax ( ) Garbage disposal 16.60
Hose bib 16.60
• 0 APPLICANT CONTACT 'PERSON
Ice maker 16.60
> -i /i .5 o � ..7..-,-) C�
Business name: d?
I � � s
Interceptor /grease trap 16.60
Contact name: Eli .. d {f C� ���C Medical gas (value: $ ) Page 2
Address: . a 30 0 Lw J 120 Primer 16.60
City / State/ZIP:- fl, 4-. 4 ,L . 0 2 ■ J f '7G� (c Roof drain (commercial) 16.60
( 3 ) �%� "c - . 5 9 S (53) �' i'c-1 ' �7 Sink/basin/lavatory 16.60
Phone: U < U Fax: - C
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR. - Water closet 16.60
Business name: L _.( 07'714io- �� G Water heater 16.60
Address: / a).--00 S ( 5 tit: lG�� dj3 Other: / 7
City /State/ZIP: 7U -,L ` C'e. s' '47O Subtotal
Minimum permit fee: $72.50
Phone: 3) �Qt s s Fax: 5 6,9,Q . o 7 0 ' Residential backflow minimum permit fee: $36.25 3 6 -
CCB Lie.: ' U Plumbing Lie. no.: Plan review (25% of permit fee)
0 � �
State surcharge (8% of permit fee) Q , 9 t:
Authorized si at�t
-+
g &' � . . J% � a TOTAL PERMIT FEE Sy /s
Print name /7 fez, - ' 4✓� Dat4t/ IO J This permit application expires if a permit is not obtained within
r [E ` 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
is\Building1Pemuts\Pt.MF -Pere app doc 12103 440- 4616T(t0 /02JCOM/WEB)
' d 89L0 269 - EOS j ai I3 di7S =ib0 SO S2 ,add
CITY OF TIGARD
1
BUILDING DIVISION PERMIT #: PLM2005- 00164
13125 SW Hall Blvd., Tigard, OR 97223 DAT ISSUED: 4/27/2005
I Phone: (503) 639 -4171
Ai, 4N� ��'�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/3/2005 TIME: 7:14AM PAGE: 117
SITE ADDRESS: 15148 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 035 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Install residential backflow prevention device for irrigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 3B7 -7530
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
f
Inspection Request Scheduled For: Date: 5/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 005833-01 503 -692 -5945 N
Corrections /Comments /Instructions:
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AWALIFMNIIV
iri v
7
a PASS-' ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Dater /�/ Phone #: (503) 718-