Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005-00380
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 8/10/2005
PARCEL: 2S 109DA -02700
SITE ADDRESS: 15235 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 004 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 HOMES Description Date Amount •
4230 GALEWOOD ST
STE 100 [PLUMB] Permit Fee 8/10/2005 $36.25
LAKE OSWEGO, OR 97035' [TAX] 8% State Surcha 8/10/2005 $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 #: L1C 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: ? A..oj ��.� Permittee Signature:
•
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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Building Fixtures
Plumbing Permit App cata:on- � FOR OFFICE USE ONLY
City of Tigard AUG 10 2005 DateBy: ' 10 QC 01- Pitcairn°.' 1 a3 d3 D
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 :u +\ Other Permit No.•
24- Hour Ins p ection Line: 503.639.41 CI OF TIGARD ,{� t� � Sari
��I D /By:
�/ 0 Sce Pagc 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISION Notified/Method: r/ (l Supplemental Information
TYPE OF WORK • FEE* SCHEDULE
For special information use checklist.
New construction ❑Demolition Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft, for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address: ) 5v; 3 s SrCU %C j .(4 a R- Catch basin or area drain 16.60
City/State /ZIP 7-) Cv1..GL 0 /t 9 7 t_?_ L/ Drywell, each line, or trench drain 16.60
Suite/bldg. /apt. no.: Project nary f�( - 1 g 1 t J ' U Footing drain (no. linear ft. ) i Page 2
t Manufactured home utilities 110.00
Cross strect/directions to job site: '
,, �1 Manholes 16.60 1
�
dr3 ree i _ 7 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
SubdivisiorS> (/rl Rt- e ( 9 t e , I Lot no.: Q 1! / Water service (no. linear ft.: ) Page 2
Fixture or it
--. s... ///
Tax map /parcel no.: 1
Absorption valve 16.60
'// DESCRIPTf N OF WORK preventer / Page 2 c _..- 7 , s S
./� �;f .S�'. i i i riff C C. t ( ci.., '!(_12 `] 64. ;/ y _ Backwater valve 16,60
Clothes washer 16.60 '
Dishwasher 16.60
PROPERTY.. OWNER .. . • 1:1 TENANT Drinking fountain i 6.60
• Ejectors/sump 16.60 •
Name: 1) [ ?` ) n (Y w q/ s s e- .L T /_i . f•J Expansion tank 16.60
Address: Li- 3 G. S L2'1 G,:�.(C. C `> Cl Oct, Fixture /sewer cap 16.60
City/State/ZIP:LCs k __, C% c Lk) ( cft;) L �_ f �f ' 0 3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) . ! Fax: ( ) Garbage disposal 16.60
,APPLICANT : CONTACT PERSON • Hose bib 16.60
Ice maker 16.60
Business name: Lai:" a GL y ' 'fi o v .-- 7 , yr1 TiP :t
Interceptor/grease trap 16.60
Contact name: 7) .... 0 afK U Medical gas (value: $ ) Page 2 •
Address: i a yD {) l ', Primer 16.60
CitylState /Z1P: - hL 4 Roof drain (commercial) 16.60
_
Phone: GS 3) (G C/ - S- 'Cj 5 Fax :: (52) 3 ('r1
C; �
Sink/basin/lavatory 16.60
7{ ._ s
Tub/shower/shower pan 16.60
E -mail:
• Urinal 16.60
• CONTRACTOR Water closet 16.60
Business name: / L /)dseLf/p.d OTC-9071 z c Water heater 16.60
Address: / v D- 0G S / (J On .f .S.,/ Cr, ,t.e : Other:
City/State/ZIP: 7j(A� �r Subtotal
Ci
tY / "" "` 4 �� y � � �U� "' Minimum permit fee. $72.50
Phone: (.5L. 3) (8QQ .59/5 Fax: (503) (0 I e 0762 F Residential backflow minimum permit fee: $36.25 3 (, ,
CCB Lie.: 7 FL)y Plumbing Lie. no.: Plan review (25% of permit fee)
/1 State surcharge (8 % of permit fee) 2. O
Authorized si a o y
(�Cgit --
� e i /Qc: TOTAL PERMIT FEE 34 , ( s Print name`! e,"") �rn� - rT,< Date This permit application expires if a permit is not obtained V it hin / 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
i:\BuildinglPermi is \PLMF- PermitApp.dot 12)03 440- 4616T( lain /COM/NEB)
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CITY OF TIGARD
BUILDING DIVISION , , . -
PERMIT #: PLM2006-00380
1 1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639-4171 404,14A
Inspection illequests (24 Hrs.): (503) 639-4175 .4.111■ f
INSPECTION WORKSHEET FOR DATE: 8/22/2005 TIME: 7:10AM PAGE: 84
SITE ADDRESS: 15235 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: .SUMMIT RIDGE LOT #: 004 TYPE OF USE: •
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: installation of backflow device.
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- A OWNER: DON MORISSETTE HOMES, PHONE #: 503.397.7538
CONTRACTOR: LANDSCAPE OREGON, INC. . PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 8/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
326 - RP/backflow preventer 013964-01 603-692-5945 N
Corrections/Comments/Instructions:
. -/--.15 . -0d..A e.,_AL L--=',_--_3
IP
0 114 , 11C
V - PASS Li PARTIAL APPROVAL 111 CANCEL 0 NO ACCESS
I I FAIL n CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: Date: - — 7 '"' ' Phone #: (503) 718-
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