Permit A l CITY OF T I GA R D PLUMBING PERMIT
I I DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2005 -00261
I II° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/15/2005
PARCEL: 2S109DA -07100
SITE ADDRESS: 15147 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 048 JURISDICTION: TIG
Project Description: Installation of backflow device.
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 MORRISSETTE COMMUNITIES
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 6/15/2005 $36.25
[TAX] 8% State Surcha 6/15/2005 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
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.
j
Issued By: Q4z.f_ � � Permittee Signature: _Size (;
l 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.
Building Fixtures
..0 .
Date/By: Other Permit No.:
Plumbing Permit At l ica�t = ioUN
FOR OFFICE USE ONL,V ,. '
City of Tigard Received
13125 SW Hall Blvd., Tigard, OR •7 23 r�o45 DateDate/By: : r Permit Nb.: \l`S_ 7OU p f
Phone: 503.639.4171 Fax: 503.598.1960 ` 1 Plan Review 1 � •b � ��e p ! /
24- 1-iour Inspection Line: 503.639.4175 \ \LWI �Ii�
•
Internet: www.cj.tigard.or.us
rg` � c '� �' n - v Date Ready/By: Juris: O See Pale 2 for
• T' , Notified/Method: r
Y J I � ll I Supplemental Information
YP F §14 } . OIN 4
•
New construction ` °� • FEE SCHEDULE
IA A' Demolition For special information use checklist.
❑ Addition/alteration/replacement s' 7 a- Description I
❑ Other: 1 Qty. 1 Ea. Total
New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION
SFR (1) bath I 249.20
IS 1 - and 2- family dwelling ❑ Corn sercial/industrial SFR (2) bath 1
350.00
❑ Accessory building ❑ Multi- family SFR (3) bath
3 99.00
❑ Master builder Other Each additional bath /kitchen 45.00
JOE SITE INFORMATION AND LOCATION Fire sprinkler ( sq, ft.) Page
Job site address: 1S /Y SW � Site utilities
{7 -cLL-t b .i t .' Catch basin or area drain
City/State/ZIP: y j _ C 16.60
7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: i Project name:S , e , 4 ¢ ` /kg g Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 1 0.00
31,U f j e 6 8 � RD-
Manholes 16.60
/� Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) 1 Page 2
Subdivision: Su-rri rn a-- /2,i e y C:. i Lot no.: Y Water service (no. linear ft.:
Page 2
Tax map /parcel no.: (p SS fir', Fixture or item
I /L> DESCRIPTION OF WORK Absorption valve I 16.60
�GI .S� . J T (. Backflow preventer / Page 2 0 7. SS
, , _ ./GI_ ;,v, .�`G_ !Y-] i„A : ,t c . i' : _) ;.,, .- Backwater valve
16.60
Clothes washer 16.60
Dishwasher
16.60
PROPERTY OWNER . , l TENANT Drinking fountain 16.60
Q l\ANT
. g
Name: D 6 �, t r � G i , / S S . .L r Ejectors /sump
-_� 16.60
Expansion tank 16.60
Address: `fa 3G, Sta, &e- ( eC.()U cwt.
City/State/Z1P: Fixture /sewer cap L6.60
._.k 0 S i3 C c y Ci OA - .7� > J Floor drain/floor sink /hub
Phone: ( ) / 16.60
Fax: ( ) Garbage disposal 16.60
. 'LAPPLICANT . I .'CONTACT PERSON Hose bib
16.60
Business name: Ice maker 16.60 eyt Contact name: �� / g L) �� {
/
Interceptor /grease trap 16.60
! �� / Medical gas (value: S
Address: j d -�()(Q .�,L1.J '1)` L ) Page 0
��E► Primer IG.60
City /State/zip:-p-a� 6.471 J 2 ' 76 ( . .
c.,..- Roof drain (commercial) I6.60
-
Phone: (S03) ( C /e�� �C`/� ( , 3) 6. S =Z �/ 16.60
/ I Fax:: �'. _ _ C, f� Sink/basin/lavatory
<r
mail: Tub /shower /shower pan 16.60
• CONTRACTOR
16.60
3usiness name: Water closet 16.60
���� S( /13-" 07-2.1e/031 �c? C, Water heater
� 16.60
/' OO � !(J fnUSEG. kin
1.ddress:
:ay /State/ZIP: -) .104. 4
/ '�� y Subtotal I j
'hone:3) /�`lta� J � i s Fax: a 6)9;2 Mini mum permit fee: $72.50
/� 69d - or / (Q g Residential backflow minimum permit fee: 536.25 36, C
-CB Lie.: 7 eV
Plumbing LTC. no.: Plan review (25% of permit fee)
uthorized signal D
(�{ ���� / iy i ` State surcharge (8% of permit fee) I g Gt
� I TOTAL PERMIT FEE 1
tint name�l � � „„ W. '
j`� ` Da /) y I OS I This permit application expires if a.permit is not obtained within
180 days after it has been accepted as complete.
S uildiny , Pcmiis \ pGb{J:- permitApp doe 12/03 *Fee methodology set by Tri- County Building Industry Service Board.
440 -4616T(10/02/COMM ED)
2 d 89L0- Z69 -EOS �ai dS� =zO SO iri ��C
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLIvM2005.00261
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/16/2005
Phone: (503) 639 -4171 a n'ui�jn
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE
6/17f 7:11 5
SITE ADDRESS: 15147 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 046 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow device.
OWNER: DON MORRISSETTE COMMUNITIES, PHONE #: 503.387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 6/17 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # • Message
325 RP/backflow preventer 009602 -01 503 - 6925945 N
Corrections /Comments /Instructions:
•
C •
. 4/0 /1, "
I`
[V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /" — Date: co/17/6c Phone #: (503) 718-