Permit CITY TIGARD PLUMBING PERMIT
All( DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00137
DATE ISSUED: 4/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA -06700
SITE ADDRESS: 15049 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 044 JURISDICTION: TIG
Project Description: 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 MORRISSETTE COMMUNITIES
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/8/2005 $36.25
[TAX] 8% State Surcha 4/8/2005 $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
PLM ALL PHASE & BA
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: jLe. 42)1).c
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 Apia ii.. -t •'' I,Q,r IV E D FOR OFFICE USE ONLY -
City of Tigard Received i
13125 SW Hall Blvd., Tigard, OR 97223 Date/By: �U 7...- Pemtit Noit,r �/3
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
AP 0 200 ` qtr e4 ep y ! t r i� 17ateBy: Other Permit No.:
gy pp,,
24- Hour Inspection Line: 503.639.4175 ry ,,` I
Internet: www.ci.tigard.or.us CITY O F TI ` �A - -� Date R /Meth : rur' Ki Supplemental See Page 2 for
`� Notified/Method:
P ®IV7�I�{N ' Supplemental Information
TY
Ig FEE" SCHEDULE
New construction ❑ Demolition - For special information use checklist.
\\ Description j Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection)
•
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
`1,1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi-family SFR (3) bath 399.00
❑ Master builder ill Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / o '
q & I L f�j � a A. FY I L>'e, Catch basin or area drain 16.60
City/State/ZIP: n G/la_ C /2 C/ 67 P"-..Lf Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name rn (...4" mar/. y (� Footing drain (no, linear ft.: ) Page 2
! ( Manufactured home utilities 110.00
Cross streetldirections to job site:
Manholes 16.60
, Lt- 6 6 e' i e.•1r,L kip Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: c- frL.rn `yt.e./- k( 4q' el Lot no.: ti 1 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: (D G S- ' 7 Fixture or item
I Absorption valve 16.60
DESCRIPTION OF WORK
Backflow preventer / Page 2 ;,. 7 s .S
/ i d 5�, nN l rr / C/ � / / 7 r 1
!l .i�1 ll.��'./ �!_!„�. /- 1 e:.; //y Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
•
. [l, PROPERTY OWNER.. ❑ TENANT
Drinking fountain 16.60
Name: Ejectors /sump 16.60
�/ Ci1 J� /if�l ,s ,s L 7 L + /�- • 1 e -S Expansion tank 16.60
Address: Q 3 G S W 6.:i_ ( e L. ) U 0e't! Fixture/sewer cap 16.60
City/State/ZIP:Lex_ x L L% S 4...0 e76 01Q- `-i .7 L3 S Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
` `
APPLICANT . CONTACT PERSON Hose bib 16.60
Business name: 1 �� ; , „,- r, Ice maker 16.60
Cr�' �� Interceptor /grease trap 16.60
Contact name: '--, J f . -
r_ , --� � � �- KO Medical gas (value: $ ) Page 2
Address: i 9' ...(0 1 ; C., i /Sy1s.$ RD Primer 16.60
City/State/ZlP:-AL/11 :•� J � Roof drain (commercial) 16.60
M a-C ; y`l-: / ij ' / lam (c c�
Phone: (Si (G• �/ - -S-97 y ' Fax: : (....5 /., ( _ �; '2&.S" Sink/basin/lavatory 16.60
E -mail:
Tub /shower /shower pan 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
•
Business name:1_4144- S( C1p 0 „ /1 !_, Water heater
J 16.60
c'
Address: 7 -D-O) S Ii) pp, Li / /;yn.( s , 12,0 . Other _ -
City /State/ZIP: '�,/� . `104. "� 7v Subtotal
Minimum permit fee: $72.50
Phone: e.'3) f0QQ J C- .. Fax: 6 6 S°� e 0710 S' Residential backflow minimum permit fee: $36.25 3 G, . .2-
CCB Lic.: 7 �{U Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signs t�L ,,q /�1u7
State surcharge (8% of permit fee) ..2 . �p
TOTAL PERMIT FEE 3 , 1 S Print name 67) ,...cl ) f D44-. 9. _ p s I 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;l BuildinglPcrmitstPLMF- PernutApp.doe 12/03 440- 4616T(10/02/COM/ wan)
z' d 89L0- Z69 -EDS ua113 eSS =6D SD BO ..tdd
CITY OF TIGARD - N
BUILDING DIVISION PERMIT #: PLM200 00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/8/2005
Phone: (503) 639 -4171 �o�u'uiUmIP41I'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/18/2005 TIME: 7:14AM PAGE: 64
SITE ADDRESS: 15049 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 044 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Backflow device.
OWNER: DON MORRISSE1 I E COMMUNITIES, PHONE #: 503 - 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 - 682 -5845
Inspection Request Scheduled For: Date: 4/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 004674 -01 503-692-5945 N
Corrections /Comments /Instructions:
,aa
PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
(l FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
a
Inspector: / �' f i J�l Date: Phone #: (503) 718-