Permit CITY OF TIGARD PLUMBING PERMIT
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PERMIT #: PLM2005 -00511
..VIII DEVELOPMENT SERVICES DATE ISSUED: 10/4/2005
III
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639-4171 PARCEL: 2S109DA -03900
SITE ADDRESS: 15495 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 016 JURISDICTION: TIG
Project Description: Backflow preventer for irrigation.
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 10/3/2005 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 10/3/2005 $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 503 - 246 -66 9 or 1- 800 - 332 -2344.
Issued By: ,i,( .) Permittee Signature: t7• a /aldh e"
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 Fixtures •
Plumbing Permit Application ®� "A FOR OFFICE USE ONLY • '
City of Tigard , i! E Received L /� /
y g �� Date/By: 1 4 Q( 3 Permit No(T 1 OD5 . � /
13125 SW Hall Blvd., Tigard, OR 9722.3 Plan Review 1 l �1M1�a�
Phone: 503.639.4171 Fax: 503.598.1960 � L n. ilk ;; rf\ Date/By:
Permit No.:
24 Hour Ins ection Line: 503.639.4175 SEP �, .i
p 1! Date Ready/By: ru' E7 See Page 2 for
Internet: www.ci.tigard.or. us /± �p Notified/Method: Supplemental Information
r JJJ i. -r i G W n !
• .• - TYPE jNsit .biviSION FEE* SC EDULE
New construction 6131E j L I J Demolition For special information use checklist.
Description Q Ea. Total
❑ Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
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CATEGORY OF CONSTRUCTION• • . • SFR (1) bath 249.20
\- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
• JOB. SITE INFORMATION AND LOCATION • ' . . Site utilities
Job site address: / LI 9S ..L) c,.- ept.6.set_, D Catch basin or area drain 16.60
City /State/ZIP: T i qi c L O "7a.p./ % Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: LL Project name: c rn i Li- ieatqe:, ! to Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
,,/ /� y, Manholes 16.60
S L C) plea t8 ei rc I€ 2 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivisions amino- eta' I Lot no.�, Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: //�
WS .. Absorption valve 16.60
DESC TION OF WORK . Backflow preventer Page 2
N 07 SS
La/ J SCI eL e, % r/ q at? U h O.� f ad ,/e.10/ e s - Backwater valve 16.60
(f Clothes washer 16.60
Dishwasher 16.60
PROPERTY, OWNER. • .1 • • ❑ -TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: bon ftncx' - i ss ' - 7 6 -i- ! k» !'S Expansion tank 16.60 '
Address: z--/ 3 C S LL! G9 - -( c-e 4.) 0 Oct_ Fixture/sewer cap 16.60
City/State/ZIP: 0 S w c7C) D /C.. 705 5 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
H bi
APPLICANT ' .. CONTACT PERSON ese bib 1
Ice maker 16.60
Business name: ' ( a S /,CJ_O- , ore() on ]'te ^ r G
Interceptor /grease trap 16.60
Contact name: 7l I F / ...Sp y -crtu Medical gas (value: $ ) Page 2
Address: i d-D-D J L u) 'rr) U S .I a � D R Primer 16.60
f,
City/State/ZIP: �(�, J � 2 7 Ci Roof drain (commercial) 16.60
Phone: (503) & c/, - S 9 ( /5 Fax: : (5"0 3) f,R - 0 'J/�. S✓ Sink/basin / lavatory i 6.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
. . CONTRACTOR Water closet 16.60
Business name: tn /LS(or.c, Oil y0-7-) �� G Water heater 16.60
Address: /' aD-OG ,S (U fyl, US./ / %y1.: Other:
City /State /ZIP: Lj Q - )/A ' 704 ; - Subtotal
Minimum permit fee: $72.50
Phone: 5 jgQ ' s e s- 6p
Fax: 60364:;? -- 070 F Residential backflow minimum permit fee: $36.25 3 � f (c' �- l
CCB Lie.: 6 U Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) r2'- . 9,,
TOTAL PERMIT FEE
Authorized signs ; ail. 7 1 I
���
Print name` / e.4 • >i Dati / �/ 3 This permit application expires if a permit is not obtained '∎ ithin
// 6 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i\ 81.1itding \PertnitsiPLMF- PennitApp.doc 12/03 440.4616T(10 /02 /COM/WEB)
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CITY FTI ARD
CI O G
BUILDING DIVISION PERMIT #: PLM2005.00511
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2005
Phone: (503) 639 -4171 � u 0n�ii il
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/11/2005 TIME: 7:08AM PAGE: 80
SITE ADDRESS: 15495 SW GREENFIELD DR CLASS OF WORK:
- 1
SUBDIVISION: SUMMIT RIDGE LOT #: 016 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow preventer for irrigation,
OWNER: DON MORISSErfE HOMES, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503- 692 -5945
Inspection Request Scheduled For: Date: 10/11/2005 Pour Time:
Code # < Inspection Description Confirm # Contact # Message
399 Plumbing final 01793402 503 - 692 -6946 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �� Dater 6/0/ / Phone #: (503) 718 -