Permit C ITY OF TIGARD PL PERMIT
D E VELOPMENT SERVICES PERMIT #: PLM2005 -00425
e�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/2/2005 .
PARCEL: 2S109DA -03200
SITE ADDRESS: 15355 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 009 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 # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 9/2/2005 $36.25
[TAX] 8% State Surcha 9/2/2005 $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: Aj � Permittee Signature: _s_,2,<_, �`1i
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 • ,
•
numbing _Permit AJ 1pallllrollkio','fll FOR OFFICE USE ONLY
City of Tigard ` °' • Received - - \,, � �,, . J
13125 SW Hall Blvd., Tigard, OR 97223 DDate/By: 9 _ a
60-5'.. ?6/7L-- Permit No. l`1' b`�+�/� ��7
Phone: 503.639.4171 Fax: 503.598.1960 � t O 20 1' Plan ate/By Other Permit No.:
24 Flour Inspection Line: 503.639.4175 �;J�L�
Date Read /B luri
Internet: www.ci.tigard.or.us y o j (t. El See Page l for
f'`ITV ne -rt�P•it•y`+' Notified/method: ' v Supplemental Informat
TYPE osIptifiktA, flli/1410N FEE* SCHEDULE
New construction ❑ Demolition for special information use checklist.
*\ E . New
J Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1- and 2- family dwelling ❑ CommerciaVindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Each additional bath/kitchen 45.00
❑ Master builder Other:
Fire sprinkler ( sq. ft.) Page
i_rs3375---- JOB SITE INFORMATION AND LOCATION Site utilities •
Job site address: f� .c l_.0 G - lre rt •{ e [d
DR. Catch basin or area drain 16.60
City/State/ZIP: '1-1 c Lt, U l - _y Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project nam ,l CJ Footing drain (no. linear ft.: ) Page 2
��mn� K\ � ` G9 Manufactured home utilities ` 110.00
Cross streeddirections to job site:
Manholes 16.60
`S L.0 3 tS { a 1 fl ctL- kip Rain drain connector 16.60 I
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. near i linear ft.:
mu-
� }- R t C. L o t no.:09 ) Page 2
Subdivision:
Fixture or item
Tax map /parcel no.: _ S A -
- Absorption valve I 16.60
DESCR PTfON OF WORK
o l Backflow preventer / Page 2 a7. $5'
!�� , %; 0'' . c !' (_ .; 4 f'. ;' ,---, . �i i :f_;�_ ;�', ^%+ ,/t' f (JL i r -'�i' Bacicwater valve
'�� ' f �. �_ 'C.• _ 16.60
Clothes washer • 16.60
Dishwasher 16.60
SI PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Name: r/ Ejectors/sump 16.60
IJ - r . . ' )C l .-> . -> r -. -:' / / t Y1.1 (' S Expansion tank 16.60
Address: eZ 3 c., • _. { ( e L 0 ()et_ Fixture /sewer cap 16.60
City/State/ZIP:Le_ ,/< (.`) \ L ' If , i c_;r 0k el 7 L 3 S Floor drain/floor sink/hub 16.60 I
Phone: ( ) Fax ( ) Garbage disposal 16.60
`=1, APPLICANT CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ,L4 o i 0: ,'C, ' , , , , - F'I n� T
N 1 C;% Interceptor /grease trap 16.60
Contact name: .
t - '1' =:.f /, t i - Medical gas (value: $ ) Page 2
Address: 5 3 0 0 (: „) u ,''g ) t. - '1
( c :o, ip v ;ZD Primer 16.60 I
City/State /ZIP: -7 y ` /i!' !i ;,^ - y :` , / _ , -77 :( Roof drain (commercial) 16 60 -
Phone: ( >d 3) /- c/..:-; - •_j��qc Fax: : /, - C; C•
Sink/basin/lavatory
E -mail: .
Tub /shower /shower pan 16.60
- -_ _ urinal 16.60
CONTRACTOR
Water closet 16.60
Business name: /-, / /_ +`_� .' �, - '
-. , �t � ' s � t. - �� i? /_� / %.'� Ali C Water heater 16.60
Address: / • .,5)- 2).- G/, c., / 2 / i y. (, ' L „tin
Other:
City/ State /ZIP: �i�,. • /' ,�l�p--� 6 , k jc ,••5 4706 Subtotal
?
Minimum permit fee: $72.50
Phone: (`��L;1) & <`�X ,S-5-;'--,,'-'.,-- _ Fax: (5 O3) 6 9Q - 0761 e Residential backflow minimum permit fee: $36.25 3O. - as;
CCB Lie.: 7 !(L.)L --% Plumbing Lic. no.: Plan review (25% of permit fee)
i et c i,ircharg!' (8% f of permit fee) ee) Authorized stgnat /� Srat
r I
Autho � , G ` (�
� - ` - ' /���� I TOTAL PERMIT FEE 139 / S" ,
Print name/./ ^7 7`"^' 1 ° Dat' - ( ti 0 ,S This permit application expires if a permit is not obtained ii ;thin
r 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
is \Building'PCrtnits%PLMF- Permit App.due 12/C3 440 .4616T(I0 /02 /COA4/WEB)
1'd 89L0 -Z69 -COS ua113 ei70 :80 SO Sz 2nd
CITY TIGARD .
BUILDING DIVISION PERMIT #: PLM2005.00425
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/12005
Phone: (503) 639 -4171 : ,> m�ii����
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEEI''"P I) DATE: 9/12/2005 TIME: 7 :04Am PAGE: 100
SITE ADDRESS: 15355 SW GR - FIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 009 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Barkfiow prevanter ford a - ion.
OWNER: DON MORISSETTE COMM ITIES LLC, G PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.692 -5945
Inspection Request Scheduled For: Da 9/12/2005 Pour Time:
p Description g
Code # Ins ection Descri tion Confirr�ir # Contact # Message
3 N Plumbing final 015365 -02 503-692 -5945 N
Corrections /Comments /Instructions: •
\\ .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /
� Date: 9 1 2 ` Phone #: (503) 718-