Permit l l
C ITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES
PE
DEVELOPMENT PLM2005-00307
�� I
4 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/12/2005
PARCEL: 2S 109DA - 03700
SITE ADDRESS: 15457 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 014 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:
TUBISHOWERS: 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 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: , i Permittee Signature: ..1k--e.... Cb /7 r
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 FOR OFFICE USE ONLY . •
City of Tigard I E C E II V E A DateBya 7 �� �j��u�- j 1
✓ Perraa No:� a lai . - 3 G 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review !t// VV
Phone: 503.639.4171 Fax: 503.598.1960 fir; Date/By: Other Permit No.:
J UL 4- Hour Inspection Line: 503.639.4175 1 0r.. "` y:
•� `� .,.._s E' I ,,, n Date Ready/By: Jur [�J Se t' a e 2 for
Internet: www.ci.tigatd.or.us g
Notified/Method: ) i � Supplemental Information
• TYPE (hiNVRli i O Llril ry FEE* SCHEDULE •
•
.; ,,tt „et=
New construction DUI it ^ tit itio
❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement 0 Other: New 1 -2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
- X1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 1
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I S'-/ c S co G 2 F �e.-c
b2 Catch basin or area drain 16.60 •
City/State /ZIP: 7 -7 q t 0/1._ Y '7 2- a-y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name h � I 9 (---1 / lJ Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site:
"` / Manufactured home uti lities 1 10.00
C � � Manholes 1 6.60
X 'c_'f C w.k. re-40 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisi on: S rY�li- 12t..et 1 Lot not() Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: /D SS� - r7'
Fixture or item
Absorption valve 1 6.60
DESCRIPTION OF WORK Bacictlow preventer / Page 2 3)7 . S S
La-n -C('_ a-PN, 1 rY / r 0-17 cm 1-6- `fe- �-' l
J / LJ2.(, �.t /,'; j i � Backwater valve 16.60 •
Clothes washer 16.60
Dishwasher 16.60 i
Drinking fountain 16.60
. IISI PROPERTY OWNER I ❑ TENANT
Ejectors /sump J 16.60
Name: b I n '/Y)o-y -f ,S• L 7& 't , l'y i.-s Expansion tank 16.60 I
Address: L.-IQ 3 Li S ;Lt &zz C c'_ z.A.) 0 Oct. Fixture /sewer cap 16.60
City / State/ZIP: Le:2_ k c, L? .. , e ro Ug.. ' 7 v3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) t Fax: ( ) Garbage disposal 16.60
• APPLICANT . Hose bib 16.60
`�CON1'ACT PERSON
l Ice maker 16.60
Business name: L i /r S e r /.,t � cry, .Z ? ,
Interceptor/grease trap 16.60
Contact name: 1 i a \, =,)
e -. C J Inte g '� Medical gas (value: $ ) Page 2
Address: / 3 �-0 ,crii) rYi VS/ /Willi IZ.0 Primer 16.60
- City/ State/ZIP: -- oL 0 k-_.. , J 7 7C, Roof drain (commercial) 1 6.60
Phone: (So 3) ( 9,:q - J ( /55 Fax:: !, 7&,(2/' Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
• CONTRACTOR Water closet 16.60
• Business name: / y,=t„it,t -S Cy .� - 7.19 v Water heater 16.60
Address: ��-(�G S /0J nn ,4� / P--in Other:
City /State/ZIP: 7l' .�-)� ' ` 47O& z,„4._ Subtota
Minimum permit fee: $72.50
Phone: t i3) je,C�a r Fa 603) (,9) „ D7l� "' Residential backflow minimum permit fee: $36.25 3 • .S
I CCB Lic.: 7 e( ) y ' r PIumbing Lic. no.: Plan review (25% of permit fee)
A-- State surcharge (u% o f pe fee) p_,. `IC)
Authorized sig na e �� ,r surcharge `" � '" permit
-' ��� TOTAL PERMIT FEE 5 I5
. Print name •`l c eF j 1 DII1 f 1 I Z l 0 S This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
i:\ Building \Perrniis\PLMF- PerraitApp.dnc 12/03 440- 4616T( I0 /02/COMAVSBI
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005"00307
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 7/12/2005
Phone: (503) 639 -4171 /�ii i i l�l�l I i 'i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/21/2005 TIME: 7 :09AM PAGE: 82
SITE ADDRESS: 15457 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 014 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow device,
OWNER: DON MORISSE i i E COMMUNITIES LLC, PHONE #: 503.387 -7539
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.592 -5945
Inspection Request Scheduled For: Date: • 7/21/2005 - Pour Time:
Code #. Inspection Description Confirm # Contact # Message
399 Plumbing final 01183.1 -02 503 -692 -5945 N
Corrections /Comments /Instructions: .
i0 / - �
I
/
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I nspector: 029
ii Date:� -� i Phone #: (503) 718 -