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Permit • CITY T I GA R D PLUMBING PERMIT 41 " DEVELOPMENT SERVICES PERMIT #: PLM2005 -00163 � ''ll 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/27/2005 PARCEL: 2S 109 DA -06000 SITE ADDRESS: 15092 SW GREENFIELD DR ZONING: R -7 SUBDIVISION: SUMMIT RIDGE LOT: 037 JURISDICTION: TIG Project Description: Install residential backflow prevention device for irrigation system. 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 Description Date Amount 4230 GALEWOOD ST # 100 LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/27/2005 $36.25 [TAX] 8% State Stu 4/27/2005 $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 #: L1C 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 -0 •ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 50-246-669* • 1 -s I '32 Issued i /' i ) Permittee Signatur�%)' /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. ECEVED I: tin znriltlimik IFfixtunv s inanniabiinE IIne)rmiit knee °® 05 'ti ' '.(44-' g ° Z.UFFIC ; : :. l�Sj.- '.. . . .. ._ Re ceived Perm • No -: • City of Tigard DateB y_ ! + / 13125 SW Hall Blvd., Tigard, - 3( !� 6S ��` 60 r F IG ARD Pl Review 83.5 8. Other Permit No.: Phone: 503.639.4171 Fax: 9 P it. , 4 n. 1p +, r t DateB 24- Hour Inspection Line: B 4 _ � l See Page 2 for ,1 R ANG DI VISIO�a w �, i: . � 0... Date Ready/By: Internet: www.Ci.tigard.Or.us � Notified/Method: � ' Supplemental Information • • TYPE OF WORK . . FEE* SCHEDULE I s] New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I 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 �- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath , 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB. SITE-' INFORMATION. A.ND.. ' LOCATION Site utilities Job site address: JS) (j.. ,l r'1 - 6.e. _fcL f).2 . Catch basin or area drain 16.60 City/State/Z1P: 'j jG C,_,, [ ( O ,t_ -/ 7a3L/ Drywall, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name . r M t.Li i f it.; C:49 e. 37 Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: e (� y� Manholes 16.60 S w Bic'` 123 2) e../') � Rio Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ____) Page 2 Storm sewer (no. linear ft.: __) Page 2 LL m �'c(9� I Lot no.: .37 Water service (no. linear ft.: Page 2 Subdivisio Fixture or item Tax map /parcel no.: to 5'5 4- , 7 Absorption valve 16.60 DESCRIPICI t)F WORK Backflow preventer / Page 2 a7. SS i m-/)4/ SL' "` �, e., i rr1 q 0__t7 -1 f / ate /J c/�y I { j Backwater valve 16.60 �' Clothes washer 16.60 Dishwasher 16.60 ....._..;....., � .... . • . .. n fountain 16.60 • Drinking f PROPHit7GY; OWNER` .. ❑ T> N& I . Ejectors/sump 16.60 • Name:' p-yl iThijr/ S S C-1 J-/c - 'y) 6S Expansion tank 16.60 Address: Lf Q_ 3 0 S l..0 G -C e_A .&7 0 act_ Fixture /sewer cap 16.60 City /State/ZTP: t✓ 0 E i..CJ - C..q() Ol.- '' 7 03 S Floor drain/floor sink /hub 16.60 / Garbage disposal 16.60 Phone: ( ) Fax: ( ) Hose bib 16.60 `�APPIACANT C© TACT•..Plu12S9N,' 16.60 Ice maker Business name: Land � i o, ' (. nip's G interceptor /grease trap 16.60 ( Page 2 Contact name: Eli � ,Sp Cgs �/(f Medical gas (value: $ ) ( rr - Primer 16.60 Address: F � a U 3� /''� U.�,l bbl L City /State/ZIP: 1) . (,g t o , c( 7(,I I Roof drain (commercial) 16.60 Phone: (S03) (0 9 - -S - 9 ( / S Fax: : o (S 3) 6 ? � - 0 7c4 Sink/basin/lavatory 16.60 '111b / shower /shower pan 16.60 ' E-mail: Urinal 16.60 -; CONTRACTOR : :. Water closet . ,.. • l L660 r• Business name: LOSCJ . ' - U)✓1 , ) G Water heater 16.60 Address: / ? ---00 E.'1 0 O- L ky) .1 i2.4 Other: `� S `� Subtotal City /State/ZIP: �- t� ��� Minimum permit fee: $72.50 Ph one: )3) &Q .5 p'�. Fax: ( 3) ‘09.? - Cr7 (� g' Residential backflow minimum permit fee: S36.25 3 to - CCB Lie.: 7 g) Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) , L Authorized signs r _ TOTAL PERMIT FEE 39. / S -\ Print name l en Da ' 3 / (JS , This permit application expires if a permit is not obtained within f� / 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. i:\ Building \Permits'PLMP- PamiLApp.doc 12103 440-4616T(10/02/COM/WEE) E'd B9L0- 269 -EOS uaII3 d9i =I0 SO 92 ,.ldd