Permit C ITY O F T I GA R D PLUMBING PERMIT
,• I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00379
DATE ISSUED: 8/10/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA 03000
SITE ADDRESS: 15309 SW GREENFIELD DR ZONING: R -7
• SUBDIVISION: SUMMIT RIDGE LOT: 007 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 GALEWOOD ST #100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 8/10/2005 $36.25
[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 #: 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), - �� 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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��i'1L1 ➢1l1I1��, 1r ll �,�:•.l:li.l '�r• ( �' �t���l� .�'- ," /�/���n'�r .
-t�1L1Q1rah.k a t� ',_�f1illl!ir,�' =il 11)1 tdon .. T - _- .. _ .__ - ._ ._.-._ - _ _ : _ • city o ftgr7: r'I� Received _ I Pemlit
13 i25 SW [Mall t31vd .'Ilbal, OR 9 722i
Date/By: I ,� / �) �1 "OQ, (/ V %
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGARC', / .., , i Date/By: Other Permit No.:
24- Note Inspection Ins ec lion Line. 503.639.4175 '' 'i' t I
1 uris-
ink:met: ww•w.ci tigard.or.us BUILDING DIVIS _. 1 Dace • Ready /By 0 Sec Page 2 for
- -- I Noti6cd/Ivtethod: J fi Supplemental Information
1. TYPE OF Woiuz - FEE* SCHEDULE
,New construction ❑ Demolition for special information use cfeeclrlisr-
- - -- Description 1 Qty. 1 Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
(:ATECDRY OF CONSTRUCTION SFR (1) bath 249.20
I �h - and 2- family dwelling - - ❑ Commerciallindustrial SFR (2) bath 350.00
❑ Accessory building ID Multi-family SFR (3) bath 399.00 -_
Master builder ❑ other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) I Page 2
30(5 .' t'i '.NPOR1MAT2ON AND LOCATION . Site utilities
Job site address: / 5 :3(71.9' S LO C'/ t e,-) - > / - 7 e.1 et, .6 n- . Catch basin or area drain 16.60
City /State /ZIP: • T ! e- G- :`ems ode_ 7 . 2- - Drywell, leach line, or trench drain I 1660
I Footing drain (no. linear' ft.: ) Page 2
Suite/bldg., apt. no Project name:
Cross strecddtrections to job site: I Manufactured home utilities 110.00
1 Manholes 16.60
�? e) e C r i o l d X-0 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ___) Page 2
Storm sewer (no. linear ft.: ) _ Page 2
Subdivision] L L /411.y 1 _f 12 C. el l e_) Lot no.:Q Water service (no. linear ft.: ) Page 2
Tax map /parcel nu. J J /. /�]
Fixture or item
( Absorption valve 16.60
')I.S( :RIPTIGOi4 O1s WORK _�. __ y Backflow prcventer Page 2 S S •
-l? ;t! "`.e ! /ii �A(7 ' ! ; ^. b� /_ .C.1{:I .1Lj _ e)) /6.,v_ Backwater valve 16.60
Clothes washer 16.60
Dishwasher I 16.60
Drinking fountain 16 60
• - Ll : t ‘.,"\. , :, - -1 s ft - ._. _ ❑ TENANT .
Ejectors /sump 16.60
Name: b /';`, K: t ', . - - /7`Crn 1 f'
Expansion tank 16.60
Address: /--- /,,),_ ..3 ! -, .r , ".. , /77t ( e iC . ,`) 0 OC Fixture /sewer cap I 16.60
City/State/ZIP: /._.C''' 1/4: - i . \ i ; C" C; CiiQ G% . 7 4_)3 Floor drain/floor sink/hub i 16.60
Phone: ( ) I Fax: ( ) Garbage disposal f 16.60
� Hose bib 16.60
A i•.
.E1 'P?. :ANT ❑ 'CONTACT PIII2SON
- -- --_ - --. _._ -_ --- -- Ice maker i 16.60
Business name: ' ! _ 7 C ,� T; Interceptor /grease trap 16 60
. Contact name: L . ;? `,`t ... ;` e. .; (/ 1...0 Medical gas (value: $ ) Page 2
Address: ' - .,,`' CJ .• ( r 1,1 1.�.', 14 33.0 Primer 16.60
City/State /ZIP: •--- , /...; , : % , J -7(, ( ,-.A.._ Roof drain (commercial) 16.60
Phone: (,':Z / - c %L!. , Fax:: , v,. -- /14,-..=.-C? Sink /basin/lavatory 16.60
- - -- Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
I ( :O1`IT".tACTOi2 - -
_ Water closet 16.60
Business name: ! ,-, /t /; ;:', , Water heater 16.60
Address: j - ;,. /j(' , ' •�/1 n � / )) r Other:
City/State /ZIP: /1, ` 4 -� '7)T �7 / T) . Subtotal - j
' / Minimum permit fee: $72.50
Phone: !:-. Fax: ,e %3 /,, 1 - o r 7 fT Residential backflow minimum permit fee: $36 25 3 4.s. - _
CCB Lie.: :f /_ - Plumbing Lic. no.: Plan review (25% of p ermit fee) - ________1
1
- i / !r - - c,ate surcharge (8% of permit ; : _ col
Authorized si t ije ,; �� ,-;�� ,/
;;. /. 3 _ 'TOTAL PERMIT FEE q , i S
I Print name: CC: ,,,./.., ; , -e ?
. '-< = ` j DDDa 1 S I This permit application expires if a permit Is not obtained •' ithin
i ((
130 days after it has been accepted as complete.
. ''Fee methodology set by Tri -County Building Industry Service 13uaru
i`, t3ui ;d:r.g;Pc:dr.•:'t..a- n.�mn:yp „r �,u 4 4o- 4 6I6T(I0 /02:CONi/WEB)
a'd 89Z-0- z68 -EDS U a11 3 et =90 SD Di 2nd