Permit C ITY OF TIGARD PLUMBING PERMIT
.,, ,{ DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00371
eel I 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 8/10/2005
PARCEL: 2S 109DA - 04700
SITE ADDRESS: 15364 SW GREENFIELD DR ZONING: R -
SUBDIVISION: SUMMIT RIDGE LOT: 024 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 ST, STE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 8/10/2005 $36.25
[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
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Phone : 503- 692 -5945
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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: .Z, cl
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
]Plumbing Permit App' t L = � FOR OFFICE USE ONLY
City of Tigard AC �G 0 Received 7 6S permit No `� 0� Q 63 7)!
13125 SW Hall Blvd., Tigard, OR 97223 2005 Dat
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
\� Date/By: Other Permit No.:
24- Flour Inspection Line: 503.639. 4404 uoTY OF TIGARD � ti ' � + r y r ° ^'
Internet: www.ci.tigard.or.us .^ _^ - -,- Date Ready/By: @ See Page 2 for
1 r1 t t e l n A Notifined/Method:
R1111 111A1/� Y y ! li(r Supplemental Information
- TYPE •OF WORK FEE* SCHEDULE .
New construction ❑ Demolition For special information use checklist.
Description I Qty. i Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings'(includes 100 ft. Co each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1 - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/Icitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
• JOB. SITE INFORMATION AND LOCATION Site utilities
Job site address: / 53 6 L/ S. w t • l P r• / 7 4 2 ��{ fJ/� Catch basin or area drain 16.60
7 City /State/ZIP: 1q Le/LeC 0 9 7 . y Drywell, leach line, or trench drain 16.60
K �f qP Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name 3wnrne.f ,ei' ay
Cross street/directions to job site: Manufactured home utilities 1 10.00
r „, �/ e � 49 • Manholes 16.60
/� e- I
Sul e +r t1 . /P• • Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
. Storm sewer (no. linear ft.: 3 Page 2
ft.: ) Page 2 linear ft
Water service (no
1 (no. .
Subdivision:Sj�'h m• �.�'- RA. �Cf -t J Lot no.0-4/
Fixture or item
Tax map /parcel no.: Co ��}:::; ,. 7
Absorption valve 16.60
' DESCRIPTION OF WORK
Backflow preventer / Page 2 , 7. 5
t` ; .� L 4 : L /� C ', , ! / / l 6 1 ter^, "f 6 - Le:A..: 7/i-' ' ,1;i,.. f? Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY. OWNER . , ❑ 'TENANT • Drinking fountain 16.60
Ejectors/sump 16.60
Name: be-P1 / 1'; (� S .S r .L /��. t S Expansion tank 16.60
Address: Li-� 3 (✓ S Liu 6 (L C.`I Ct OC( Fixture/sewer cap 16.60
City/State/ZIP: /c L, 0 ,S i_j e e J C) ...),0--- ...),0--- '1 .7 (J- � .> Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 •
APPLICANT `CONTACT PERSON Hose bib l 16.60
name: // Ice maker 16.60
Business
f '�� �«to"�� o���� Tom/^ Interceptor /grease trap 16.60 j •
Contact name: '' ' f \ : . r
,� r ,! ,�o� J � ��`� �.� ,✓� - �3 Medical gas (value: $ ) Page 2
Address: 1 - -L: J . ,- ) li) Ljs. / t Li iZt Primer 16.60
City/State /ZIP: i t ! �- r / 1 Roof drain (commercial) 16.60
� 1 . tL� i t1 v k - 7G) (C
Phone: (SL �3) (G /• -.S Fax:: e - C '7e.:-_
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60 1
E -mail: Urinal 16.60
- CONTRACTOR Water closet 16.60
Business name,/ ("1/-f1 t i _S(;,: f • O ) C Water heater 16.60
Address: / ECG• s //.) n/1 J S- tyl k t pD Other:
/1 �/ Subtotal
City /State/ZIP:
l< t-,,- Jim " 7U(O Minimum permit fee: $7250
Phone: (`jLe t�D -3 t ' 9/ / Fax: 603) ( n 07 cog' Residential backflow minimum permit fee: $36.25 3 ( P S
CCB Lie.: 7 s-O L/ Plumbing Lit. no.: Plan review (25% of permit fee)
Authorized sign' j p�,.l ,_0
1(6 a_.i�rJ��7 Sta. �.c? arO (8° of permit fee) U
```�i ✓✓✓�t�� i TOTAL PERMIT FEE 39 . fs
Print name 2 // eil , fit e- ) Date q /C) This permit application expires if a permit is not obtained "ithin
I 180 days after it has been accepted as complete.
• *Fee methodology set by Tri-County Building Industry Service Board
1:\ Building \Pcmtims \PLMF- Pernvt App. doc 1 2/03 440- 4616'x(10 /02/C0
2 'd 139L0- 269 -COS ua11 eBS :Oi SO GO 2nd
F
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2005 00371
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2006
Phone: (503) 639 -4171 i ooti�ypiip�ale'lll
Inspection Requests (24 Hrs.): (503) 639 -4175 `__..
INSPECTION WORKSHEET FOR DATE: 8/12/2005 TIME: 7:06AM PAGE: 70
SITE ADDRESS: 16364 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 024 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 -5945
Inspection Request Scheduled For: Date: 8/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 013401 -01 503-692-6946 N
Corrections /Comments/ Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED / Y r Inspector: D at e: v Phone #: (503) 718-