Permit CITY TI G ®RD PLUMBING PERMIT
� i DEVELOPMENT SERVICES
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PERMIT #: PLM2005-00381
���I DATE ISSUED: 8/10/2005
PARCEL: 2 S 109 DA -02900
SITE ADDRESS: 15295 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 006 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
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Owner: FEES
DON MORISSETTE HOMES
4230 GALEWOOD ST Description Date Amount
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STE 100 [PLUMB] Permit Fee 8/10/2005 $36.25
LAKE OSWEGO, OR 97035 [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.
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Issued By: / _ 1�1� Permittee Signature: (� \ t �
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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, s
ii, Building Fixtu g�g CE �� E"
II IIL�
Plumbing Permit A ppliea i� •
City of Tigard
gib Lam" FOR OFFICE USE ONLY .
Received
13125 SW Hall Blvd., Tigard, P 1-92 F TIGARD Date/By: y-10-0.5- Permit No.: "" f U . )
Phone: 503.639.4171 Fax: 503.598. _9 }0 Plan Review ` O� /
51
24- Hour Inspection Line: 503. 1� � DIVISION m� t" '�
■ ' '' � I Date/By: Other Permit No.:
Internet: www.ci.tigard.or.us * - - vi 'I\
DateReadyBy: . r s .
Notified/Method: Sea age 2 1'or
TYPE OF,.WORK Supplemental lnformation
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New construction FEE SCHEDULE
• ❑ Demolition For special information use checklist.
El Addition /alteration/replacement J Description J Qty. Ea. Total
0 Other
New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF. CONSTRUCTION le SFR (1) bath l 249.20
1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath
350.00
1=1 Accessory building ❑ Multi- family SFR (3) bath
399.00
❑ Master builder Other: Each additional bath/kitchen 45.00
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•. JOE S1TE INIFORMATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
• Job site address: � Site utilities
/57i-[ S ul 6 , Gn L( et Ors Catch basin or ar d
City/State/ZIP: 16.60
77 0.�� CJi"2.. 9 7 . ) - 9 - Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project nan , n , a � Q Footing drain (no linear ft
!�-C ) Paget
Cross street/directions to job site: Manufactured home utilities 110.00
SW Bt° a�'1 ; / f� Manholes 1 6.60
vl 1� Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisio Water service ) P
wl � 1�' /�( �C� f Lot no() (no. lin ear ft. Page 2
Tax map /parcel no.: �, Ss Fixture or Item • - " DESCRIPTION OF WORK Absorption valve 1 6.60
Backflow preventer i rr; g / Page 2
� y� y , 7. 5 - s-
I
""` )d Sc a p J 651n ha flow fll-C.� �-1 i [ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
.' 'PROPERTY.•QWNER ... ❑ TENANT Drinking fountain 16.60
(Yr s t° f f li e J Ejectors sump 16.60
Name: bori
Address: 1 .--/Q 3 p Expansion tank 16.60
S w 604. ( e.C� U CSC Fixture /sewer cap 16.60
City/State/ZIP: k c (DE w e'
`I G 0 k- 33 5 Floor drain floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal
16.60
' ' APPLICANT . Hose bib
/ ^ � C PERSON 16.60
Business name: L al i s efit O,P T G Ice maker 1 6.60 C
Contact name: EL/ t interceptor /grease trap 16.60
I J a rry Medical gas (value: $
��� ) Page 2
Address:
m 1 /,.c - i�m� Primer 16.60
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City/State/ZIP: - t - 11 (t a m p ' G � , .7G Roof drain (commercial
1 "� 16.60
Phone: (Ss? 3) (o `�9yJ� I Fax: : (jpJ) �, y� _ C7 ',7& Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR
Business name: 4 eis na , ^� an-19,0-71 � c
Water closet 16.60
"`f✓ Water heater • f 16.60
Address: 7,2 S a) � l • /(4. l7 ,� Other:
City/State/ZIP: � 0 ( � s .� l v � . , . . Subtotal
I
Phone: (j(J / � OQQ � J�• Fax: � � e r Minimum permit fee: $72.50
7 ' 7 Residential backflow minimum permit fee: 536.25 ,3(p • 3S
CCB Lie.: 11 �S p Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signal L � / �. State surcharge'(3% of permit fee)
Print name 87/ / / TOTAL PERMIT FEE 3q /s
Lr 4 Datk/ )U1 US This permit application expires if a permit is not obtained within
( 180 days after It has been accepted as complete.
:\ Building lPemtiis \PLMF- PerxnitApp doe 12/03 *Fee methodology set by Tri -County Building Industry Service Board.
4 40- 46 16T(10/02/COM/WEB)
uail3 e6E =8D SO OT end
2'd 89L0- 269 -EOS
CITY,OF.TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00381
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/005
Phone: (503) 639 -4171 1 0/ 41 i ill
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8122/2005 TIME: 7 :10AM PAGE: 81
SITE ADDRESS: 15295 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: „ 006 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE.
DESCRIPTION: Installation of backflow device.
OWNER: DON MORISSETTE HOMES, PHONE #: 503 - 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5945
Inspection Request Scheduled For: Date: 8/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013967 -01 503. 692 -6945 N
Corrections /Comments /Instructions:
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ASS I I PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /�Z a one #: (503) 718-
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CITY OF TIGARD
A BUILDING DIVISION PERMIT #: PLM2005.00381
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/10/2005
Phone: (503) 639 -4171 i1 � � iiii10
Inspection Requests (24 Hrs.): (503) 639 -4175 s !J'i
INSPECTION WORKSHEET FOR DATE: 8/22/2005 TIME: 7:10AM PAGE: 82
SITE ADDRESS: 15295 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 006 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow device.
OWNER: DON MORISSETTE HOMES, PHONE #: 503 - 3874538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 692 -5945
Inspection Request Scheduled For: Date: 9/2312006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 013966 -01 503.692 -5945 N
Corrections /Comments /Instructions:
v'1■ 5 .
ii iiri s i
k
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i ._ . -
• 1 ._ , .r
17 n PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �\�. . Date: 0/2 LS Phone #: (503) 718-