Permit C ITY O F T I CARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00279
��JII 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/21/2005
PARCEL: 2S 109DA - 05000
SITE ADDRESS: 15298 SW GREENFIELD DR ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 027 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 COMMUNITES LLC
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 6/21 /2005 $36.25
[TAX] 8% State Surcha 6/21/2005 $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: jL = Permittee Signature: _c;_. CI) .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.
t
'`," ' IE ullitai ing Fixtures
Date/By: lPuannnn�nlrn ��� Q� � n r� �,. ,
(( F {.y4t�} d s"?1 �! '� �Yr scsaa�
City of Tigard %1/ � v L ' :r a ; ?� � � t , ti o R' p � R ! @ E ; • U S p L ' w: ::,; S u
Received • ' "' .
13125 SW Flall Blvd., Tigard, OR 97223 n� Da , /'(3
Phone: 503.639.4171 Fax: 503.598.1960 JU +r 1 Permit No.: \ .. � � n
Plan Review 1 , . / _ !
24- Hour Inspection Line: 503.639.4175 200 x`1,1. "
Internet: www.ci.tigar 5s t ` Other Permit See
rE� l l]:.;.
Date Ready/By: /M e rho _
CITY op rlr . A n Notified/Method:
En la See Page 2 for
TYP }(O �1VOR "' Supplemental Information
�IV 4R�
FEE* SCHEDULE
`New construction .
ED Demolition. For specie! informations use checklist.
❑ Addition/alteration/replacement Descri.tion
❑ Other: Qty. Ea. Total
CATEGORY OF CONSTRUCTION New 1 -2- family dwellings (includes 100 ft. for each utility connection)
\� [ - and 2- family dwelling SFR (1) bath S
249.20
Commercial/industrial SFR (2) bath _
El Accessory building 350.00
CI Multi - family SFR (3) bath
11:1 Master builder 399.00
❑ Other: Each additional bath/kitchen
4
JOB. SITE INFORMATION AND LOCATION Fire spri sq. ft.) -�
Job site address: / �" 9 Site utilities
City /5tate/ZIP; -- ` ' .• Catch basin or area drain
('n „ y 1 6.60
Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name ' M s -
trench �� Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities
Cross street/directions to job site: 1111. 1 10.00
•
Manholes
16.60
Rain drain connector _
16.60
t/ (no. . Sanitary sewer (no. linear ft.:
) Page 2
idi Storm sewer (n linear ft.: ` _j _ Page 2 IIIIIIIIEII
An Subdivision: M adv.) to .
� Lot no.: Mater service (no. linear ft.: ) -
Tax map /parcel no.: (0 s.s ) 4 Aliiii
Fixture or item
D OF WORK Absorption valve 16.60
�i ; ^/l..S /, j'�' Backflow preventer
y „
J._ r/ ( (/ f .');V: ; '..6/..r`!�_" / ,,�' .. Page 2
,. i; i Backwater valve _
16.60
Cloches washer MN 16.60 •
Dishwasher 16.60
[] PROPERTy OWNER ...
C] TENANT Drinking fountain _
Name:
16,60
1) l , 6TY7 Ss r' ,/ )' ) Ejectors /sump 16.60
��y
Address: 3 `, S Expansion tank 16.60
t� <<.( �t) Cl oet
Ci /State/ZIP: G, Fixture /sewer cap 16.60
Lc� k G C l..t 3 <"G C) O '70.3 5 Floor drain/floor sink/hub _
16.60
Phone: ( ) Fax:
( ) Garbage disposal _
; A •
. ,PPLI ,. .. . 16.60
CONTACT I'1; (tSON Hose bib 16.60
Business name: /�fo,s; C lee maker -
7 ?Q °C. G6 e ('my\ .L ,'? 16.60
Contact name: r r , i Interceptor/grease trap 16.60
Medical gas (value: $ ) Pa
Address: . �tD(� ; f , t
t.✓ r L / .3 u RD Primer
2
Primer 16.60
City/State/ZIP: �l 7d1. J
�- �G' Roof drain (commercial) 16.60
Phone: (5-0 ) CG' arc-). - -5 iy•
Esmszimis Sink/basin /lavatory l 6.60
E-mail: Tub /shower /shower pan
]6.60
• CONTRACTOR Urinal 16.60
Business name / Water closet 16.60
G_S;(:l r U i2. [ ' f'1
Address: 7.7.../2 C, • Water heater
/ D- S / r�' . c-/ 1 6.60
City/State/ZIP: � G� lJ °�`'� Other:
'hone: c �� _ Subtotal
� i�' a N'� Minimum permit fee: $72.50
JCB Lic.: 7 0(..) • Residential backflow minimum permit fee: $36.25
PIumbing Lic. no.:
_
Plan review (25% of permit fee
/
authorized siQ ar c y )
(
on ir :'Li�8',„.! - .�i, - %// .e i� ' State surcharge (g% of permit c ' `
- tea .. y' v� /
Tint name c t TOTAL PERMIT FEE
�<:
p-/ This permit applitin o e ir a permit is not obtained within
196 da ca after i haxps bes een if accepted as complete
BuildinglYe: milslPLA4 F- Pcrntiulpp_do 1"2/03 *Fee methodology set by Tri- County Building Industry Service Board.
440.4616 T( 10 /02/COM /\EB)
2'd 139L0- 269 -EOS uati9 d9E =2T SO T2 ur'C
, MR
CIT TIGARD pir-t
BUILDING DIVISION PERMIT #: MST2005 -00062
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/24/2006
Phone: (503) 639 -4171 Am °�� ' u 4piviigfil til
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/24/2006 TIME: 7:09AM PAGE: 6
SITE ADDRESS: 16298 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 027 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: New SF
OWNER: DON MORISSETTE COMMUNITES LLC, PHONE #: 603- 387 -7638
CONTRACTOR: DON MORISSETTE COMMUNITIES LLC PHONE #: 6 603 -387 -7538
Inspection Request Scheduled For: Date: 6/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 010126 -01 603 -209 -4837 N
Corrections /Comments /Instructions:
i q
. O V
G ,
a v .,-
. .
-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION (l ADDITIONAL FEES ASSESSED
Inspector: Date: L -L Phone #: (503) 718-
/717)