Permit CITY TIGARD PLUMBING PERMIT
''' o 1 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00312
�- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 63 -4171 DATE ISSUED: 7/14/2005
PARCEL: 2S 109DA -03500
SITE ADDRESS: 15403 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 012 JURISDICTION: TIG
Project Description: Install residential backflow prevention 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 HOMES Description Date Amount
4230 GALEWOOD ST
STE 100 [PLUMB] Permit Fee 7/14/2005 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharp 7/14/2005 $2.90
Phone : 503 387 - 7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD. REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
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 -246 -..•9 • 9 ,, 1- i 0- 332 -2344
G7 _
Issue By: A I / $1-444 - 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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Build Fixtures R E C E O V E J
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Plumbing Permit Application FOR OFFICE USE ONLY .
City of Tigard Il I 1 6 j r Received g � ./
Y g Jvl_ 1 �O�,J Date/By: 7 / l OS 14/ Permit No.:{ ._,
13125 SW Hall Blvd., Tigard, OR 97223 0 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIG ! /r4n,;� ^,1,\ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 BUILDING DI; t1j Date Ready/By: / tit
RI �. W R Sec Page for
Internet: www.ci.tigard.or.us Notified/Method: / J L�f ///��� • Supplemental Information
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TYPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. [ Total
❑ Addition/alteration/replacement I ❑ 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 ❑ Commercial/industrial SFR (2) bath 350.00
I=1 Accessory building SFR (3) bath 399.00
g ❑M ulti - family
❑ Master builder I=I Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. (i.) Page 2
' JOB, SITE INFORMATION iS,ND LOCATION • Site utilities
Job site address: j /5 3 $(j3 - f 7 t* (GL 2 JD Catch basin or area drain I 16.60
City/State /ZIP: . Y1 t / &11GL O k i -col
9 7 ,.-C-/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project nary [( in (I / . I / Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
/� Manholes 16.60
-c‘-0 /•6 e•L c<- /- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
SubdivisiorELLrn,n,1 Li-- /2 -f G(.. .e.---1 I Lot no.:/ a__ Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: 60 l 5- / Fixture or item
Absorption valve 16.60
DESCR TION OF WORK
• , . Bacldlow preventer / Page 2 .47..5
r C - 6;s1-4✓..Se °C (",, en-/ r Cam? ha.0 /fn(.l G�' 5 /(N, Backwater valve 16.60
t Clothes washer 16.60
Dishwasher 16.60
PROPERTY.. OWNER - I ❑, TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: b i ft) (Jy7 s 'S C_ i 7' / )"✓) e- j Expansion tank 16.60
Address: 1-f a 3 c S UC.-.y (lam (C'.. L`) O OC'L Fixture/sewer cap 16.60
City/State /ZIP:L.Cz k C, O -S Lii t G G am' - c--1 / 63 S Floor drain/floor sink/hub 16.60
Phone: ( ) / Fax: ( ) Garbage disposal 16.60
APPLICANT F RCONTAC PERSON Hose bib 16.60
Ice maker 16.60
Business name: f ir, -fl (/ .� t;ZI f ) -f� � Tt!\
_ Interceptor /o ease trap 16.60
Contact name: /- f°
,� ��f L4`i-6 Medical gas (value: $ ) Page 2
Address: j , t-0 I3 .c ,,i,.0 J a Primer 16.60 •
City/State/ZIP: ; i t 0 a_ , -7 J ( �� Roof drain (commercial) 16.60
Phone: (5613) J 1:(- - - - - -9(7/ 5 Fax: : (5 & 7:: _ G '7&.,•c' Sinlc/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60 1
CONTRACTOR Water closet 16.60
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Business name: / J ,, / <(e .� O_9J-n p v Water heater 16.60
Address: i' - /,�J) pp, L 4'L'Y.LJ Ri' Other:
/State /ZIP: �f�/ Subtotal
tY • -" � � ✓�
Ci - ` 70& Minimum permit fee: $72.50
Phone: ( -e.:3) (1, s''K s Fax: ( - 03) to' . p7 0 g Residential backflow minimum permit fee: $36.25 ...SC - o • 4)--S
CCB Lic.: (1) Plumbing Lic. no..
Plan review (25% of permit fee)
State surcharge (8 o f P-
er fee) � , 96
Authorized signa �+ ^ � � � c TOTAL PERIv1ITFEE ,39, S
Print name •1f eV) ,-"Ci-e<r0 i Dan /, 3 10 . _c -
j r.' OS 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.
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