Permit CITY TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: P 20/200 -00352
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/20/2006
PARCEL: 2 S 109AD -15100
SITE ADDRESS: 14955 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 4 LOT: 133 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 COMMUNITIES, LLC
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 7/20/2006 $36.25
[TAX] 8% State Surcha 7/20/2006 $2.90
Phone : 503- 387 -7538 Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -5945
FAX 503- 692 -0768
Reg #: LIC 7804
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: � / Permittee Signature: j ., ic)j \\j n,�
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
`f ~.r, t..
Building Fixtures EcErvE®
Plumbing Permit Ap ICatlon FOR OFFICE USE ONLY
L 2
1 006
City of Tigard 3U L Y Received permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 D F TIGARD De te/sy: 7 n ? Q6�'! � ! . ? \VN; 4j - 0 6 3lr
Phone: 503.639.4171 Fax: 503.598.t96(PIT I$ IO Plan Revie
ILDIN DiV ._,. 10 0. �'' Date/Sy: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 B V .1 i I •
Internet: www.ci.tigard.or.us
Notified/Method: ` °= '.'' Ready/By: _�+ Q See Page 2 for
fic e - r Supplemental Information
�� 1 I Suppleme t'un
: - ' FEE. 'SGIIEDU'LE'
�' New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. ; Total
❑ Addition/alteration/replacement ❑ Other:
New - am dwellings (includes 100 t
2 -f, y e t g for each utility connection)
,.. '• `:: ATEGORY:: OF CO R (I) bath fo l C 24920
i
c n {
1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ MuIti- family SFR (3) bath I 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Ire n c e ( sq. ft.)
.:; :, ,...:.. J013'•SITE •INFORMATION ,AND , LOC.4 FLON .. _ ... g
spn r s t. Page 2
.... r ,. -. ... S utll
Job site address: / Li-q sr264 - f5 br` (X. Catch basin or area drain 16.60
City/State/Z1P: T?ga_tf_ d l_ 9 -�/ 7 ;)--? i �- 14:496 X33 - Drywel'., leach line, or trench drain 16.60 __
i� 1rn cam-
Suite/bldg. /apt. no.: 6 Pro 1 / Footing drain (no. linear It. Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
lJ
l 8 � Manholes 16.60 '
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2 '
Storm sewer (no. linear ft.: ) Page 2
Subdi - m L i- �L -
n cuq G• I Lot r� 3 Water service (no. linear ft.: ) Page 2
Tax map/parcel n .: �/J Fixture or item
Absorption valve 16.60 • DESCRI) tiii t WO -- - • .`. . ;' : : ,:: .. , r' Backflowpreventer J Page 2 D. ? . SS
L Zi./• l( /' i "'. . •' 7 ?-7/ 7" . ). _ • , Backwater valve f 16.60
/ Clothes washer 1 6.60
Dishwasher 16.60
1PA O SG OWNER..
Drinking fountain 16.60
PERT
�� Ejectors sump 16.60
Name:
;� . . .r�;f; i; �; :. .:: L ,- . C•. urn mu rr ES Lt _Expansion tank 16.60
Address: - /,.` .3 t._ < 1..L._ e: :, ._ ! ._: L' c , '. (.. Fixture/sewer cap 16.60
City/State /ZIP:L., 4' !� `. f t - (1 r": j ; ;/. Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
IIose bib 16.60
APPLIC,,4.NT: ONTACT..PERSON•, .
Business name: i , . Ice maker l 6.60
.f Interceptor /grease trap 16.60
Contact name: _ : - , �/ , e : ` - a_ Medical gas (value: $ ) Page 2
Address: i D D cc < L.t j'Y i L i i i ' ' K.LJ Primer l 16.60
, . , Roof drain commercial
City/ State /Z1P: /LA [..0 it S: C: r: ::. • _. „ . - ( (commercial) 16.60
Phone: (Sr.' ' ) -, - -.f> _. =, Fax : (I . ;) . - . -- Sinit/basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
::z: C
Water closet ., _ ONTRACT'Olt, :, l
W 1 l
Business name: L i /4z; - /'r -•.•
'/ j ,E r Water heater 1 6.60
Address: y.l�, / f•_„• / r �'; :/ l/ Other: i
City /State/Z1P: 71CL(.-t'e< -4-if- 'J G 4-7y00 Snbtotal
/ Minimum permit fee: 572.54
Phone: ( 63) �Q,� - 'C?Y Fax: 60'3) C�.o9 -- 0 c](�, g Residential backflow minimum permit fee: S36.25 3SA t _
CCB Lie.: 7 ! b L/ Plumbing Lie. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) a 2 ,, tb
Authorized signs ? 39 , 1 S
6 F. �l ; a (- TOTAL PERMIT FEE
Print name• a en r -)cz - - Jr--ZCi) DO/ f 1 ' n ! This permit application expires if a permit is not obtained thin
1 l i� 180 days after it has been accepted as complete.
*Fee methodology set by Tri- Counry Building Indusuy Service Board
i:\Building\Perr its'rLMF- PmmitAp.dnc 12/03 440 46 16T(Ie /G2 /COM/WEB)
I "d 89L0 -ass -COS u dLE :20 90 6T IBC
CITY OF TIGARD { •
BUILDING IVISION .v04- -60 3 �j�
G
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 41714�u i �"
Inspection Requests (24 Hrs.): (503) 639 -4175 ��'!!,L -� �L
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: L-tdl t 1 C Ar n - CQ�� Dia. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code #4 Inspection Description Confirm # Contact # Message
I uvv ce Cwt 6 r-O
Corrections /Comments /Instructions:
•
PASS n PARTIAL APPROVAL n CANCEL n NO ACCESS
I FAIL n CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
c /
Inspector: Date: / Phone #: 503
( ) 718-
CITY OF TIGARD
PLM2006 -00352
BUILDING DIVISION PERMIT #: 7/20/2006
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
7/21/2006 7:01AM 67
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
14955 SW GREENFIELD DR
SITE ADDRESS: SUMMIT RIDGE NO.4 133 CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 4 LOT #: TYPE OF USE:
PROJECT NAME: SaGb'Iavv prev enter enter for irrigation.
DESCRIPTION:
DON MORISSETTE COMMUNITIES, LLC, 503 -387 -7538
OWNER: LANDSCAPE OREGON, INC. PHONE #: 503-692.5945
CONTRACTOR: PHONE #:
7/21/2006
Inspection Request Scheduled For: Date: Pour Time:
Cc # I romp 1 eJcription %MIR i , W189 5 Message
Corrections /Comments /Instructions:
•
/ 7 4/ -
In PASS [ ' A 'TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Pr , J Date: Phone #: (503) 718-