Permit C ITY OF TIGARD PLUMBING PERMIT
,r, I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00262
DATE ISSUED: 6/15/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109 DA - 04500
SITE ADDRESS: 15412 SW GREENFIELD DR ZONING: R - 7
SUBDIVISION: SUMMIT RIDGE LOT: 022 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 # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 6/15/2005 $36.25
[TAX] 8% State Surcha 6/15/2005 $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: / j ,d 'or 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.
Building Fixtures .
Plumbing Permit Application Received
g ED
City of Tigard * et" �1 FOR OFFICE USE ONLY
13125 S W Hall Blvd., Tigard, OR 972 9� ,L[ // _ Oc 76) Permit No: ( j
Date/By: 6- /X 1 V�
Phone: 503.639.4171 Fax: 503.598.1960 i Plan Review r
24- Flour Inspection Line: 503.639.4175 1�� 1 2VS I k '�1�+� Date/By: Other Permit No.:
Internet: www.ci.tigard.or.us �
S 3 _ 1
//�� Pr �" ..a Date fie ReeadyByo :
luris.
!'1 �1�+� " n^ // I El See Page 2 for . ` v t�1 Noti on
U I Supplemental Information
- . TYP/Lb sVORONI1� V
63 New construction e L� ' " • FEE* SCHEDULE
❑ Demolition For special information use check!lsr.
i
❑ Addition/alteration/replacement
Description ( Qty. . I Total
I Ea
❑ Other:
New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION
1 -and 2- family dwelling
SFR (I) bath I 249.20
❑ Commercial/industrial SFR. (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath
399.00
❑ Master builder Each additional bath/kitchen
❑ Other: 45.00
•
.. JOB. SITE INFORMATION 'AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Job site address: 1 S ' a Site utilities I
�� �� &jet e,-- mr & l e t De__ Catch basin or area drain
City/State/ZIP: G �,L 16.60
Cite,_,.. 62 7 -;?- Drywall, leach line, or trench drain 1 6.60
linear drain
Footing
Suite/bldg. /apt. no.: Project nameS"J�}t1-t4 / g (no, near ft.:
) Page 2
.e �'
Cross streeUdirections�t job site:
Manufactured home utilities .
7' C ��LCC 1 10.00
S4_1.% C Manhole 1 6.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) i Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: rylryl Lf- Rta. ,
7 f- f Lot no.:.------- Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: � 64 7 Fixture or item
1 . DESCRIPTION OF WORK Absorption valve 16.60 7
/ .flow preventer
) 6��1 C2; r rte• ;/ Backwater valve
Paget a7 .s$
. 16.60
Clothes washer 16.60
Dishwasher 16.60
PROPERTY_ OWNER. . I ' • Drinking fountain
❑ 'TENANT
16.60
Name: 7)6 r x -1 s s ` 7 �e / -S Ejectors/sump
16.60
Address: ! f a 3c) S r Expansion tank 16.60
6 � 4 `�� f ' ()CC,. Fixture/sewer cap
City /State/Z1P:(�_k� 0.S C �� G, 7 3 c 16.60
/ Floor drain/floor sink/hub 16.60
Phone: ( ) ( Fax: ( )
Garbage disposal 16.60
• `APPLICANT CONTACT" PERSON Hose bib 16.60
Business name: ; Ice maker 16.60
Contact name: i Interceptor /grease trap 16.60
�>I i .> on :S p 04
/
Address: / � -�O � ( � Medical gas (value: S ) Page 2
Yl. rn v,S-1 II mi j 1Z0 Primer
Ciry ^tLt /State/ZIP:- 16.60
` a4 fk , OP--- ' A; 0 Roof drain (commercial)
3) et CG' C/e� -S-9 16.60
/��j l Fax: : (.5-3) 3) F;;-/ _ 6 ��� Sink/basin/lavatory 16.60
?hone: (s
mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal ( 16.60
•
3usiness name: Water closet I 16.60
SC. • -E. 077-.16 Uri d�ri G Water heater
address: a�0G 16.60
fp, U 01:1 - Other:
'ity /State/ZIP: ` �►� n •iU,z,
hone: 3) �, 7O( `� Subtotal
�`�� S Fax: 5;a3) / Minimum permit fee: 572.50 /
C0 " U��O g Residential bacicflaw minimum permit fee: $36.25 �tP -
:CB Lie.: 7 �() Plan Plumbing Lie. no.: {
an review (25% of permit fee)
uthorized sign (4/..,, t - ! State surcharge (8% of permit fee) a. • 5'0
int name TOTAL PERMIT FEE f S
Da '/ fp b This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
uildinglPem.. o\?LM 12/03 *Fee methodology set by Tri -County Building Industry Service Board.
44 0-4616T( I 0/02/C OM/WEB)
' 89L0- Z69 -EOS uai i3 eEi; =LD SO ST une
•
/ CITY OF TIGARD
. BUILDING DIVISION ' ' PERMIT #: PLM2005-00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/15/2005
Phone: (503) 639-4171 "11119111t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/28/2005 TIME: 7:09AM PAGE: 84
SITE ADDRESS: 15412 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 022 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
. DESCRIPTION: Installation of backflovv device.
; OWNER: DON MORISSETTE COMMUNITIES LLC, PHONE #: 503-387-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 6/28/2005 Pour Time:
1
Code # Inspection Description Confirm # Contact # Message 1
325 RP/baskflow preventer 010304-01 503-692-5945 N
Corrections /Comments/ Instructions:
.....____
`PASS .0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
fl FAIL 0 CALL FOR INSPECTION Li ADDITIONAL FEES ASSESSED
Inspector: i iA\d Date: .67_91/ Phone #: (503) 718-