Permit ,1
CITY TIGARD PLUMBING PERMIT
.6 ..,, Ail DEVELOPMENT SERVICES PERMIT #: PLM2005 -00523
' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 2S 109DA -02800
SITE ADDRESS: 15273 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 005 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
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 Description Date Amount
4230 GALEWOOD ST STE 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 10/6/2005 $36.25
[TAX] 8% State Surchan 10/6/2005 $2.90
Phone : 503 387 - 7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
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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 -669 or - 800 - 332 -2344.
Issued By: r� Permittee Signature: /i %� �.4
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.
{, '`, ,
Building Fixtures RECEIVED
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Plumbing Permit Application
0 FOR OFFICE USE ONLY
City of Tigard O CT Received /
13125 SW Hall Blvd., Tigard, OR 97223 �' Date/By: O � rJ Permit No. i _.00,-.07,3 1= $ r, Other Permit No.:
o , Plan Re
Phone: 503.639.4171 Fax: 503.598.1960
CITY OF C ' F' ` ` Date/By:
Hour Inspection Line: 503.639.4175 f 1 1■ y
Internet: www.ci.tigard.or.us BUILDIN •, a,l , cCA Date Ready/By: 3 "^" 0 See Page 2 for
Notilied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
\RNew construction ❑ Demolition For special information use checklist. •
Description I Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement D Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
SFR (1) bath I 249.20 I
I -and 2- family dwelling CATEGORY OF CONSTRUCTION
❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
` Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION_ Site utilities
Job site address: ( sO) 73 Z12L.�
d �� 671Z°elj{j C !C Catch basin or area drain 16.60
City/State/ZIP: % /gef--L.LL Qk_ q7 p_pay Drywall, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project narrul MryL1 ,t6tq . CAS Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
7 Manufactured home utilities 1 10.00
/� Manholes 16.60
S" to Q J eel- na� r ``A ' Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisio ry)jij . - RL ci I Lot no �1 S ' Water service (no. linear ft.: ) Page 2
ll Fixture or item
Tax map /parcel no.: S
Absorption valve 16.60
DESCR7PT ON OF WORK Backflow preventer / Page 2 ) 7 .SS
• `- 4 - C.! e.-40(`', l fir/ 9U- - fn ^fie- 2��' G/r( t >5i / Backwater valve 16.60
/.' i ,
Clothes washer 16.60 _
Dishwasher 16.60 • PROPERTY. OWNER . I . 0 •TENANT Drinking fountain 16.60
Ejectors/sump 16.60 I
Name: Der y: ;2)C SS .-f r /*) Y) C'.
Expansion tank 16.60
Address: ' - f c L 3 C - ' S Lkj [7 ,-i_ C c s: U O C?t.
L. Fixture/sewer cap 16.60
City/State/ZIP:Ln_. < C. 6 % LC e 70 CIS ‘j' 7 (- 5 Floor drain /floor sink/hub 16.60
Phone: (. ) Fax: ( ) Garbage disposal 16.60
APPLICANT )1\ ONTACT PERSON Hose bib 16.60 I
Ice maker 16.60
Business name: Leer t f : /C /_ t or /);� r-,--) `, I
r Interceptor /grease trap 1 6.60
Contact name: ' Y ! I - �� i L Medical gas (value: S ) Page 2
Address: i 3D L .�. �) d g
3 ;1 � / �.,. M ( / q 2 0 Primer 16.60
City /State/ZIP: L a _ 1 0 k_ . J •7G, L Roof drain (commercial) 16.60
Phone: (sit ) (.G' C1,- - -Sf C/ e Fax:: (S - _ 0 Sink/basin / lavatory I G.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR _ Water closet 16.60
Business name: L4:4_4 a se p� / � � G Water heater 16.60
Address: / ; D- S
00 . E.l ,/ =f.:5 i. C y i ;P Other:
City/State/ZIP: ' f a rl ✓ 6)'Z 4 1 Subtotal
Minimum permit fee: 572.50
Phone: 3 ) &Q,,,� ,S S L 9c Fax: (503) o 0 t� 6 Q` Residential bacicflow minimum permit fee: 536.25 3 (p, QS
CCB Lie.: 7 eL/ Plumbing Lic. no.: Plan review (25% of permit fee)
n
Authorized si a i State surcharge (?% of permit fee) oZ , go
t � a � _2_ * -O TOTAL PERMIT FEE 3 / S'
Print name // eil 7a,,,� J J I Dat`(j - 6- Qt g This permit application expires if a permit is not obtained „ithin
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board
i:\B uildinc \Pccrnis \PLMF- PeruutApp 12/03 440- 4516T(f0 /02/COM/VEEJ
I ' cl 89L0- 269 -E0S u 9 II 3 e62 :L0 SO 90 400
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CITY OF TIGARD
BUILDING DIVISION . '` PERMIT #: Pl_M20Q6 -00523
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/6/2005
Phone: (503) 639 -4171 A u° Ili
Inspection Requests (24 Hrs.): (503) 639 -4175 -�±i
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7:08AM PAGE: 82
SITE ADDRESS: 16273 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 005 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow preyenter for irrigation. .
OWNER:. DON MORISSETTE COMMUNITIES LLC, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
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Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 017933 -02 503 - 692 -5945 N
Corrections /Comments /Instructions:
/- JO
/ :
[SS I PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,
1 Date: / i Phone #: (503) 718 -