Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES -
-
Tigard, Hall PERMIT #: PLM2005 13125 SW Hll Bld., Tid, OR 97223 503-639-4171 DATE ISSUED: 7/12/2005
PARCEL: 2S 109DA -03600
SITE ADDRESS: 15421 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 013 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 7/12/2005 $36.25
[TAX] 8% State Surcha 7/12/2005 $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:' �� t� Permittee Signature: C1:51
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.
r
Building Fixtures •
Plumbing Permit App'lI OII VED FOR OFFICE USE ONLY • • . ,
City of Tigard ! Received /� ,K-d-1......
13125 SW Hall Blvd., Tigard, OR 97223 JUL. Date/By: 7 ' I� -V 5 Permit No 7, 42 45 o ) f a
Plan Review
•
Phone: 503.639.4171 Fax: 503.598.119 2005 /ba *n y v l � ; ; � ( +\ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.1 �q OF TI(� ' i� Date Ready/By: lu^ D See Page 2 ['or
Internet: www.ci.tigard.or.us 1 IAin _ hit r. RD `^ °"f Notified/Method: lv Su pplemental Information
TYPE OF WORIL''IUJ .. FEE* SC7IEDULE •
'\
New construction E1 Demolition For special information use checklist.
�� - \ \\ Description J Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 fl. for each utility connection)
CATEGORY OF • CONSTRUCTION SFR (1) bath 249.20
dwelling S (2) 1
I- and 2-family g ❑ Commercial/industrial Obath 350.00 i
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ O ther: Fire sprinkler ( sq. ft.) Page 2 -
JOB SITE INFORMATION AND LOCATION ' Site utilities
Job site address: /5 l S [„v /a'& ii- iCL- p Catch basin or area drain 16.60
T g
City /State /ZIP: a,LeA 40 /& _ 9 ! 'P-D-1-1 'P-D-1-1 7 Drywall, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 6 l Project name: Footing drain (no. linear ft.: ) Page 2 i
Manufactured home utilities 110.00
1
Cross street/directions to job site: 1
S (.1-) A e.�F `ji2_ii /2-0 Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
•
Subdivision: . 5 L/nry∎ /Q- t-aq� ( Lot no.:/3 Water service (no. linear ft.: ) Page 2 1
Tax map /parcel no.: CO 5S A 7 Fixture or item I
Absorption valve 16.60
• DESCRIPTION OF WORK Backflow preventer / Page 2
X 7. 55
/�_ d sc L _ i r / 9 C.t cal r U t y JC J /L'Lt) f- re.t;i / e��., Backwater valve 16.60
Clothes washer 16.60
Dishwasher . 16.60
Drinking fountain 16.60
PROPERTY. OWNER. • I . ❑ TENANT
Ejectors /sump 1 6.60
Name: 2) (f) f S S._1 # / - eS Expansion tank 16.60
Address: L-7 3 0 S ti i &- (e L-, D 0 ° I_ Fixture /sewer cap 1 6.60
City/State/Z1P: )._.kG (),St i ( c)Cj C�/.. o f '7(_: _3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) / Fax: ( ) Garbage disposal 16.60
'APPLICANT : CONTACT PERSON Hose bib 1 6.60
Business name: J/ `�, / Ice maker 16.60
L /l ' -r' (...„,_.f., Gl - ef / � .Z ri Interceptor /grease trap 16.60
Contact name: '-'J 1 ,
�e J ,.,�1. • �i- {�-(i>'l'Crl}' Medical gas (value: $ ) Page 2
Address: / D - C)0 c•U) J 1W Primer 16.60
1 � m
City/State/ZTP:T I a &h , o p_ . , � 7j 7G (0 Roof drain (commercial) 16.60
t 1 "` < < Fax: : (5-0 - C; 7&,..S/
Sink/basin/lavatory 16.60
Phone:
(50:3) !c J:.g -S /(/5 3) 6 S�SZ
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60 6.60
Business name: / �
1 - SC 4 {, O , 6) - nj -7 ? c , Water heater 16.60
Address: /' „2--.D-00 ,S a Nl , l s,A J Other:
City/State /ZIP: , -in `JUR. '4 706, _ Subtotal
�� Minimum permit fee: $72.50
Phone: ( 5 ( � 3 ) ! r te a S' Fax: (5 6,9o? - 07 0 ,Q' Residenttal bacicflow minimum permit fee: $36.25 :See
CO3 Lic.: 7 E y Plumbing Lic. no.: Plan review (25% of permit fee)
!. n State surcharge (8% of permit fee) , 9 b
Authorized signs f ,
�-g! e l�az..,,L...9-1_Ci TOTAL PERMIT FEE I ,39, / S I
Print name: 1/ .S 'J -C-L) Dat7 r /( /6 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.
i:\ BuildinglPe rmits1PLMF- PermitApp.doc 12103 440- 4616T(10/0 /COM/WEB)
2 B9LO 269 - EDS u aii3 e2E =TT SO II IBC
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200E00306
13125 SW Hall Blvd.; Tigard, OR 97223 DATE ISSUED: 7/12/2005
Phone: (503) 639 -4171 i oppglfll)lii'I\
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/20/2005 TIME: 7 :11AM PAGE: 46
SITE ADDRESS: 15421 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 013 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: 7/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 011779-02 503 -692 -5945 N
Corrections /Comments / Instructions:
/41/
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: r Phone #: (503) 718-