Permit CITY TIGARD PLUMBING PERMIT
, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00664
�iI DATE ISSUED: 12/1/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S109DA -04800
SITE ADDRESS: 15332 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 025 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
4230 GALEWOOD ST STE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 12/1/2005 $36.25
[TAX] 8% State Surcha 12/1/2005 $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: 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 a ° '
Plumbing Permit Application FOR OFFICE USE ONLY -
City of Tigard NOV 3 U 2005 naceisr �U " 4727/ � C '41M :20A 5-
a0 66 9
13125 SW Hall Blvd., Tigard, OR 97223 Permit No.:
84 6 � i / Plan Review
Phone: 503.639.4171 Fax: 503.5 .9
9aI `� l�Vfi i �" I((''Ij Other Permit No.:
D ate/By:
24- Flour Inspection Line: 503.639. 51 DWI i
Internet: www.ci.tigard.or.u F UMING Jv " E Naze Ready/By: fu j hit p e entalInf
Notified/Method: 9 r� I Supplemental Information
TYPE Or WORK FEE* SCHEDULE
N
New construction ❑ Demolition For special information use checklist.
\ \\ Description 1 Qty. I Ea. I Total
❑ Addition/alteration/replacement - ❑ Other: _ - New I- 2- family dwellings (includes 100 ft. for each utility connection) .
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
\- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
13 Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/lcitchen 45.00
. I Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 33 a,., _ U G ir L11 ,e..ia o ..._ Catch basin or area drain 16.60
City/State/ZIP: T1 Gj .A.L( �d �( 7 ? y i Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: f Project name
u 6(9e , �S Footing drain (no. linear R ) Page 2 i
Manufactured home utilities 110.00
Cross street/directions to job site:
E3
,/ , (� Manholes 16.60
e t
8)2 -d- ,., Rain drain connector 16.60 1
I
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
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Subdivisions LLf'n M LI- '_./ l Lot no.:p2 Water service (no. linear ft.: ) Page 2
-
Tax map /parcel. no.: � S" Fixture or item
- Absorption valve 16.60
DESCRIPTION OF WORK
-_ Backflow Backflow preventer / Page 2 0_7.
it 1,`') ,,; .;(' a 2/C'': : / ; ' / 0(27. (del ! i, !.s:�t7:'l I 1e<„ 1 ;_:fir °1' -;-! ' Backwater valve 16.60 1
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
• R PROPERTY OWNER- ❑ TENANT
- Ejectors /sump 16.60
Name: b / lilt-K.1 ,S i� 7 7 .. / y.f J Expansion tank 16.60
Address: 1 -f, 3 L. S CC L. (e C. tL ) 0 c ( Fixture /sewer cap 16.60
City/State/ZIP:LC- /C L C). S L ;3 t' c� j 0 l � '7 Li _$ G Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
SIAPPLICr1NT ❑ PERSON Bose bib 16.60
/ •- Ice maker 16.60
*Business name: l2/_ / ^ /.(S /'C� %. !D! �' n .
Interceptor /grease trap I 16.60
Contact name: ,i Medical l gas (value: $ ) Page 2
Address: I "' . D C (. u. 1 ' y ' ..! c / y`t td ;2 .O Primer 16.60
t -
City /State /ZIP:1 ` Gt t- : , -. S7 i , u: Roof drain (commercial) 16.60
Phone: (56/3) (e; - -.5- Y S Fax:: ( f ) ''.3) 6_-. >' --t - L-' ,,7,%:' . Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
---- .. Urinal 16.60
• CONTRACTOR Water closet 16.60
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Business name:Lai)d_S / .,._ - e. -t- Water heater 16.60
Address: / ;� - -OG a i {_) ?'; , ' .c, , y∎ t, ,Z,:D Other:
City / State/ZIP: 77A`q 'G;� -? / j 0,4%. ) .._ ‘ _
_a_ Minimum permit fees $72.50 3
Phone: ( 3) 6.<4;74 S VII:: Fax: (5O3) (n9 0 7�; E' Residential backflow minimum permit fee: $36.25 3 to -as
CCD Lie.: 7 gUy Plumbing Lic. no.: Plan review (25% of pennit fee)
Authorized ^i a i r State surcharge (8% of permit fee) ,) L
v'- ✓ U "* 1 -4.< ,r T OTAL PERMIT FEE 3g ,
Print name 1 f e 1 _ . a ..,- v - - Dal 3o 0 c• ---- This permit application expires if a permit is not obtained thin
f 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
i:l Building )Permits \ELMF- PemitApp doc 1 540 4616T( /02 /COMANED)
a'd 89L0- Z69 -EO5 u a113 dOS :EO SO OE AQN
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.006ff
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 12/1/2005
,'!4 ''
Phone: (503) 639 -4171 sti ° � �
Inspection Requests (24 Hrs.): (503) 639 -4175
;
INSPECTION WORKSHEET FOR DATE: 12/6/2005 TIME: 7:02AM , • PAGE: 6
SITE ADDRESS: 15332 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 025 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow preventer for irrigation.
OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503-387 -7530
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692 -5945
Inspection Request Scheduled For: Date: 12/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 023017 -02 503- 692 -5945 N
Corrections/Comments/Instructions /
7; c / ps .
/I / `'P' 3 0..., ,,,,,
l ) . -
g 4 —PgS_S _PARTIAL APPROVAL n CANCEL U. NO ACCESS
1 ] FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
1�
Inspector: " �l Date: 1 >7 t i 9 / S Phone #: (503) 718 -