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Permit • C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 -00229 I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2005 PARCEL: 2S109DA -05200 SITE ADDRESS: 15252 SW GREENFIELD DR ZONING: R -7 SUBDIVISION: SUMMIT RIDGE LOT: 029 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 MORISSETTE COMMUNITIES, LLC 4230 SW GALEWOOD ST #100 Description Date Amount LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 6/2/2005 $36.25 [TAX] 8% State Surcha 6/2/2005 $2.90 Phone : 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. Issued By: '7 s� Permittee Signature: j -c 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. is -- , Building Fixtures 0 Plumbing Permit App lioati.0 FOR OFFICE USE ONLY , City of Tigard / Received 99 x � o � Date/By: 6 oZ. - / / ) t - Permit NarF \ � 1,v& / o✓ 0 13125 SW Hall Blvd., Tigard, ini 1V.2.23 •�� Phone: 503.639.4171 Fax: 50'.5`8.1960 % � °® ,/ Date/By: view y �, Q► • ii., I ' DateB Other Permit No.: 24 Hour Inspection Line: 503.639.4175 \ Internet: www.ci.tigard_or.us \ �.' N`S \" .. Date Ready/By: AA- See Page 2 for ..4 Q _ 1) NotiSed /Met edltvtethod: /� Supplemental Information • TYP FEE* SCHEDULE N ew construction 1�� ❑ Demolition For special information use checklist Description I Qty. J Ea. I Total • ❑ Addition/alteration/replacement ❑ Other: New 1 2 family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION . .• SFR (1) bath 249.20 and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ A \ \ \ ccessory building ❑ Multi - family SFR (3) bath 399.00 • ❑ Master builder ❑Other Each additional bath/kitchen 45.00 Fire sprinkler ( . ' JOB SITE INFORMATION<.ANAE.'LOCATION 9 ) g • spri kler s . ft. Page 2 '" Site utilities Sob site address: / S Q-S 1( Cr.O _ _,_ i' Catch basin or area drain 16.60 City/State/ZIP: 77 9C�44, _0/e_ 'T 7,.2--a C,7 Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: Proj ect nmes'a jort i&LL - RA_ erlq e 029 Footing drain (no. linear ft.: ) Page 2 7 Manufactured home utilities 110.00 Cross street/directions to job site: PG n Manholes 16.60 ciAJ U e4'2c( Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: (.UN\ - CA-C fe.._ J Lot no •z_q Tax map /parcel no.: Lo 47 Fixture or item Absorption valve 16.60 DESCRIPTION OF Wf?RIC Backflow preventer Page 2 a7.3" L--ar) �c / y (,/ Clef J 0 1 j (�E e fj(J]�;I 1 { Backwater valve 16.60 t1 Clothes washer 16.60 Dishwasher 16.60 . nn fountain 1.5 PXtOPE D kingf n L6.60 . `: t�l, : .,: OWNER.:" `FENAPI ' • Ejectors /sump 16.60 Name: Dim tho s tt f /. Y'i es Expansion tank 16.60 Address: t---/,, 3 p S. uJ Gam.( t_,e_t_D 0 6eL Fixture/sewer cap 16.60 City/State/ZIP:Li:12-/Q 0 E w -eA© QA, 9' 5 Floor drain/floor sink/hub 16.60 Phone: ( ) / Fax: ( ) Garbage disposal 16.60 'ICANT ._" ..".'";;'`'. CONT : P ACT.ERSON" . Hose t 60 Business • APPL name: L__l�n � S Ice maker 16.60 o�egv� / r.„-,-) Interceptor /grease trap 16.60 Contact name: el/ sr an - - Medical gas (value: $ ) Page 2 Address: / } a-- ()C rn vs-IA-Yu ) Primer 16.60 City/State/ZIP; - fL4 . ((P -jr, a , 70(0D-- Roof drain (commercial) 16.60 t 5 .So Sink/basin/lavatory 16.60 Phone: (SO 3) (o r1a'�I(/ Fax: Qa -G7( > Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 • ••CONTRACTOR Water closet 16.60 , Business name:Lai) ctSc p 0-}-rL orn ..„/..? G Water heater 16.60 Address: / ?--D--001 S w nel Li _ G 7 n Other: City/State/ZIP: "O f7 06,, ,_ Subtotal �"/�• Minimum permit fee: $72.50 Phone: 6503) /0YQ S-91-45.- Fax: (50) 6,9a - 076, g ` Residential bacicilow minimum permit fee: $36.25 34 - _.S CCB Lic.: 7 et, Plumbing Lie- no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) a, y(, Authorized sign / f TOTAL PERMIT FEE � , /S Print name•8-`/ ei r0 -r ) Da6/ 3, / �` This permit application expires if a permit is not obtained within l 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ BuildinglPenniis ■PLMP- Pcrtr4tApp.doc 12/03 440.4616T(10/02/COM/WBB) 2 ' d 89L0- 269 -EOS ' - 9 iI eSj, =OT SO LE ReN • CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005.00229 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2/2005 Phone: (503) 639 -4171 / n t Inspection Requests (24 Hrs.): (503) 639-4175 4111- __.. INSPECTION WORKSHEET FOR DATE: 6/6/2005 TIME: 7:13AM PAGE: 75 SITE ADDRESS: 15252 SW GREENFIELD DR CLASS OF WORK: ' SUBDIVISION: SUMMIT RIDGE LOT #: 029 TYPE OF USE: PROJECT NAME: SUMMIT RIDGE DESCRIPTION: Installation of backflow device. OWNER: DON MORISSETTE COMMUNITIES, LLC, PHONE #: CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945 Inspection Request Scheduled For: Date: 6/6/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 325 RP /backflow preventer 008487 -01 503 -692 -5945 N . i ')‘. \p _ Corrections/Comments/Instructions: , • / ' _= A WAErAINIF - _ _ Allir. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS _ FAIL ❑ CALL FOR INSPECTION [1] ADDITIONAL FEES ASSESSED Inspector: ` ('' k_____, Date: / ( P / ° Phone #: (503) 718 -