Permit 4 .*
CI TY OF TIGARD PLUMBING PERMIT
l+j DEVELOPMENT SERVICES PERMIT #: PLM2005 -00257
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/13/2005
PARCEL: 2S 109DA -05100
SITE ADDRESS: 15284 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 028 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 STE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 6/13/2005 $36.25
[TAX] 8% State Surcha 6/13/2005 $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: j. A ) Permittee Signature: , .� p�� ,
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. 1
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.
` f• h.. •
Building Fixtures 0®
Plumbing Permit Apat �� FOR OFFICE USE ONLY • • '
City of Tigard � Received y _// � " � 46` Plan Review
Date /By: a _ Of 71/L/ Permit N6: �� I „zs
\\V‘ 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Ai. ` il�. �
s•,q 1 Other Permit No.:
t' `��sy :
24- Hour Inspection 503.639.4175 00- �� , 1111
D
Internet: www.ci.ti ard.or.us «^- : �.' Da atd R y: fuP See Page 2 for
.%\5.)% Notified/Method: ��Cr Supplemental Information j
TYPE OF FEE* SCHEDULE
■ New construction ❑ Demolition For special in ormation use checklist,
Description Qty. 1 Ea. i Total
❑ Addition/alteration/replacement 0 Other: New 1 -2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
el l- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.0D
Accessory building SFR (3) bath 399.00
El rY g ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 15 2 u t
/ I'�C/1 � t'leC etc / Ue._ Catch basin or area drain 16.60
City /Sta.te/Z1P: T q r tGL O/2,..,, g7 P-e,3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project na ( R.. dq>r ng Footing drain (no. Linear ft.: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
Manholes 16.60
S U'\ 1 e_ e T L �1 �'v ek R,51 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: .S Urn to �-- R` ; t d ( ei 1 Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: S ,q-7 Fixture on item
/ Absorption valve 16.60
DESCRIPTION OF WORK
Backflow preventer / Page 2 .'7 .
L- .'Lt:(` .c, / ' ; r 0l/ cr 1, evoz ' ,- -4 >: ; i i „ Backwater valve 16.60
il Clothes washer 16.60
Dishwasher 16.60
C), PROPERTY- OWNER I ❑ :TENANT
• Drinking fountain 16.60
Ejectors/sump 16.60
Name: b'm /73067v-/ S S c -:L + /^, ) &S Expansion tank 16.60
Address: z---la 3 C' •S u-i '' -e. e &. 2
0 Oet Fixture/sewer cap 16.60
City/State/ZIP: L s. X C 0 .. r i Si t'.ici C)/. y " L3 S Floor drain/floor sinlc/hub 16.60
Phone: ( ) ! Fax ( ) Garbage disposal 16.60
APPLICANTCOeNTACT PERSON
Hose bib 16.60
•
Ice maker 16.60
Business name: La/^ a f C'eee -�.: Cy/r'f_'C' ,n T'-f•? C.; interceptor /grease trap 16.60
Contact name: � / % . 51 � (_ /i " gas (value: ) Page 2
� i Medical as value; $
Address: i 2-.D-DC) Y 3 nfl id /1)1 U, 1.2.D Primer 16.60
City/State/ZIP:- tI t �� J 2 , 7 ' 7(r (0 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503) e.G' ----5 Fax:: (.53') i2'Z
F -
,-- ' `7&,(.? rY
Tub /shower /shower pan 16.60
E- mail:
Urinal 16.60
CONTRACTOR Water closet 16.60 /,
Business name: /-..J(.1!)4SC f . arry ,..',./? Water heater I 16.60
Address: /,?.--00 S / iy /•, t. R.4 Other:
City/State/ZIP: J Subtotal
ff����`` � UI 4• Minimum permit fee: $72.50
`' I�Yt� .� 5 5'03) (.. I O? °' 0 70 permit �S
Phone:
(,3[J,3) Fax: Residential bacicflow minimum ermit tee: $36.25 3�' '
CCB Lie.: 7 [} c1)17, /' �P Lie. no.: Plan review (25% of permit fee)
M surcharge /�
�/ [.-�'I ate �.Ch < �f fee) .
Authorized si a �'a V[._ rt_<
TOTAL t r°. - e)
�.
Z�
/ TOTAL AL PERMIT T FEE 39. /S
Print name`/ ,y'a - i ZT J DatLOJ f 3 /D' This permit application expires if a permit is not obtained with in
�� f 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Build ; \PLMF- PemtitApp.doc 12/03 440 -46I 6T(I0/02 /COM/WEB)
T' 89LO -ass -EOS uaiI3 eTS =ii SO ET unC
CITY OF TI -
BUILDING DIVISION PERMIT #: PLM2006-00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/13/2006
Phone: (503) 639 -4171 U p Npuy�iuppJi�l�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/17/2005 TIME: 7:11AM PAGE: 8
SITE ADDRESS: 15284 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 028 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow device.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 603 -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
399 Plumbing final 009600-02 503-692-5945 N
Corrections /Comments /Instructions:
•
•
•
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: L / 1 7 / 6 c — Phone #: (503) 718-
CITY OF TIGARD , ` -
BUILDING DIVISION PERMIT #: PLM2005 -00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/13/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/17/2005 TIME: 7:11AM PAGE: 9
SITE ADDRESS: 152.84 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 028 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow device. •
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503- 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5946
Inspection Request Scheduled For: Date: 6/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /bacl4low preventer 009600-01 503- 692 -5945 N
Corrections/Comments/Instructions:
3 5 Tk..)U. - 8 •
•
PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 Date: 1/ 7 /Phone . #: (503) 718-