Permit •
1.v v TIGARD
1 OF 1 IGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00375
DATE ISSUED: 8/10/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S109DA 04600
SITE ADDRESS: 15380 SW GREENFIELD DR ZONING: R - 7
SUBDIVISION: SUMMIT RIDGE • LOT: 023 JURISDICTION: TIG
Project Description: Installation of backflow device.
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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
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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 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
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: Q
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 i:StUIlL a �Q���
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P ermit i %,V „ . , -r�_ -.� rF: ,rte, fr. -7**r �z,,-, -.;,-
Plianm n Applific ltib l ,,FOttrc PF E l u ` av - 71 ,F
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City of TEgard �O Receive
13125 SW Hall Blvd., Tigard, OR 9 0 P O DatrBy _ _ � Permit �l0' 1�v o Gd i/S
0 Plan Review
Phone: 503.639.4171 Fax 503.598.196 + �lV
\C"' - \C " Atilt,., ','11 Date /By: Ocher Permit No
24- 1-Tour Inspection Line: 503.639.4175 G'
,�y „%
O ( ,ia \S `} 1 ,., . ;1t iJ ,
? ;..� Da te Read /B farm
Internet: www.ci.tigard.ocus Q\ Notified/ Ready /13y: �� ` S Sec Page
upplementa l For
Ci, Method: J ' Supplemental Information
• TYPE OF - FEES SCHEDULE
ew construction �� ❑ Demolition For special information use checklist.
Description Qty. Ea. Total
❑ Addition/alteration / replacement ❑Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
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CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
E] Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑Other:
Fire sprinkler ( sq. ft.) Page 2
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JOB SITE INFORMATION. AND LOCATION
Site utilities
Job site address: I S a go S4 eptc-c4 -6 eL�-( c.� Dk_ 16.60
Catch basin or area drain i
City/State/ZIP: 'T /' a� Q q 7 ]-D- Drywell, leach line, or trench drain 16.60
• Suite/bldg. /apt. no.: `1 Project nam &�Lm ( f Footing drain (no. linear ft.: ) p age 2
Cross street/directions to job site Manufactured home utilities 1 10.00
SL 0 t 8- a 'e� Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft: , ) Page 2
Storm sewer (no. linear ft.: 1 Page 2
Subdivistot LmM t 1 � e( Q,J f Lot no 3 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.G SS' AL -7 Fixture or item
/ Absorption valve 16.60 •
. DESCRIPTION OF WORK a S
' Backflow preventer f Page 2 a7
C<- / ; c -C-C_ ( i , i rri 0 C Cam✓': ( e" f - il1LLl c e.); / (I;' Backwater valve 16.60
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Clothes washer 16.60
Dishwasher 16.60
PROPERTY: Y: OWNS l2 Drinking fountain 16.60
❑ TENANT
i1 //)G�yl S S r- . - / O-M t� J Expansion tank 16.60
Name: 7) 0
Address: �a 3 0 S Ott Expansion tank 16.60
��' � L i a �}`� Fixture/sewer cap 16.60
City/State/ZIP: . kG C.) -S Le C ro U ' .7 3_3 S Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
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[APPLICANT [g CONTACT PERSON •
Hose bib 16.60
Ice maker 16.60
Business name: /fi y i // ., /'.C(.. -r C /''e-' 'r?'1 1%7'1 v
/ Interceptor /grease trap 16.60
Contact name: e • '_ rte: -
a � t�� -� ; % Medical gas (value: $ ) Page 2
Address: f 9 � (• d ' g
B �t.J✓ a tL,y' � Primer 16.60
City/State/ZIP: I C C Roof drain
d t L. v -- 7 7� r� (commercial 16.60
Phone: ( O.3) (. </) - Sjy I Fax: : ( L, 5.':;t - C- , 1 67 ,_G Sink/basin /lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
_ Urinal 1 6.60
CONTRACTOR • - Water closet 16.60
Business name: U, S- � c 16.60
Jti� �i�=�' '1 Water heater
Address: / ?-,..-00 �� ,^
�" . .� f � �� '- .yr- ��; i-I! +2.:� Other:
City/State /ZIP: Q Let. -?n ✓0� 76)(0; Subtotal
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Phone: (571. ':..3 ) ���� -S- Fax: , Nfinimum permit fee: $72.50
�) ��nC t� Residential backflow minimum permit fee: $36.25 j
CCB Lie.: 7 eO C/ I / Plu Lie. no.: Plan review (25% of permit fee)
- Authorized signatt L � ( 7L � � / °.,L !/ �
, Slat rpe (?o ; Q ? peen;. on v2 . �2e) / !� TOTAL PERMIT 3/ ST]
Print nameJ7 I - -� G! , ,_� Dat• f This permit application expires if a permit is not obtained st i ''��`��t 7 � �C�S P PP P� p thin
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
iASa Odin g\Pennits PermitApp.doc 11(13 •14a- 4616T( I0 /02 /COMWEB)
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CITY OF TIGARD .
BUILDING DIVISION Ctf./ PERMIT #: PLM2005-00375
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2005
Phone: (503) 639-4171 egidovillq\
Inspection Requests (24 Hrs.): (503) 639-4175 I
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INSPECTION WORKSHEET FOR DATE: 8/22/2005 TIME: 710AM PAGE: 86
SITE ADDRESS: 15380 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 023 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow device.
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OWNER: DON MORISSETFE COMMUNITIES LLC, PHONE #: 503_307-7630
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
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Inspection Request Scheduled For: Date: 8/22/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 013963-02 603-692-5945
Corrections/Com ents/Instrs:
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PARTIAL APPROVAL El CANCEL n NO ACCESS
LII FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: VL (ft/
Date: Sfb S Phone #: (503) 718-