Permit C ITY OF TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00251
11 DATE ISSUED: 6/8/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 109DA - 04900
SITE ADDRESS: 15316 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 026 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:
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 6/8/2005 $36.25
[TAX] 8% State Surcha 6/8/2005 $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
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: 14(j rjet Permittee Signature: -e.. 93 �l\
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 Applic'itl E I FOR OFFICE USE ONLV-
WALL/ . City of Tigard DateBy: - 4 I IL, Permit No 7 y , )-- - 1
13125 SW Hall Blvd., Tigard, OR 97223 JUN Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 J� ®� e'Kyy, r.' tk Date/By: Other permit No.:
24- Hour Inspection Line: 503.639.4175 ll t t,. i I r
W Date Ready /By: 9 ' ' 0 See Page 2 for
n
Internet: www.cl.tigard -ous � j CITy OF Ti _ Not J /U Supplemental Information
TYawi r G ARD FEE* SCHEDULE
•
T ,�J r
New construction ❑ Demotition I--io For special information use checklist.
Description I Qty. I Ea. ? Total
❑ A dition/alteration / replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 249.20
l - 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 AND LOCATION Site utilities
Job site address: i S z % ( f .e. CC_ OA= Catch basin or area drain 16.60
City /State /ZIP: '7-7 L u 1 C� C:„/„C cr 7 51 Drywell, leach hne, or trench drain 16.60
f yL• `� / L Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name.��ry? r K.� et '
Manufactured home utilities 1 10.00
Cross street/directions to job site: {
Manholes 16.60
. W 6 e el .6... -L L /2_.O, Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision..(L net (f- k p�ct y Lot no.: v.1._ 7 Water service (no. linear ft.: ) Page 2
Fixture or
Tax map /parcel no.: 6 .5.5- .4 7 item
Absorption valve 16.60
//
DESCRIPTION OF WORK Backflow preventer / Page 2 ,� 7. SS •
• /_a.r, / ..jc_`.O f)! / r r / 00 c ,-∎ f (-,, (,(_ ^l - fiL.7,f] 6./ .; / , Backwater valve 16.60
` Clothes washer 16.60
Dishwasher 16,60
Drinking fountain 16.60
PROPERTY. OWNER I . • ❑ TENANT
Ejectors /sump 16.60
Name: t/ 07, rim,-,v7 S S (: + /-,/ e j Expansion tank 16.60
Address: c-/a 3 C_• .. U It 6lc t Lt) 0 oc'Z Fixture/sewer cap 16.60
City / State/ZIP:/ : /0 , C.:: S uj 1 Q /Q- % C2`3 5 Floor drain/floor sink/hub 16.60
Phone: ( ) / Fax ( ) Garbage disposal 16.60
APPLXCANT CONTACT PERSON • Hose bib 16.60
Ice maker 16.60
Business name: Lf C^ a S (y/ Ore_L/ Z'' C Interceptor /grease trap 16.60
/
Contact name: ;; s l %?,-) ...S lcs F' - -l Medical gas (value; $ ) Page 2 . U) Address: i 0 0 D J Primer 16.60
Ci / State/ZIP: J �- Roof drain (commercial) 16.60
t�s C . f (Cl c�. 7G' � Sink/basin/lavatory 16.60
Phone: (SO 3 ) (e- ----- �%C/ S Fax: : (52 t `/ca - C' / / 7- '/?
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
• CONTRACTOR Water closet 16.60
Business name: c Water heater 16.60
. Address: / -O Q S to ' i r, 1 ,,1 , f ty U Other:
City /State/ZIP: ` U € L P- r J 04. `77 04., :7-1-- Subtotal
/� Minimum permit fee: $72.50 _
Phone: 64.3) (p7r� �S Fax: 5 - Co - O7(pg Residential baclkflow minimum permit fee: $36.25 3(p - r s
CCB Lic.: 7 .0 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8 o fpe permit fee P... . 90
ha �+ / n ^ 7 s� -� �•• ••-- -_
c (��L µ TOTAL PERMIT FEE 3 e-". /S1
Authorized sig
Print name j/ et,-) er�'�'IJ'u� Da t f ( This permit application expires if a permit is not obtained ,, ithin
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i.\Buiiding \Permits \PLMF- PennitApp.doc 12103 440- 4616T(10/02/COM/WE➢)
2 d 89L0- Z69 -EOS ua11 dZE:Z0 SO SO unf
CITY OF TIGARD
BUILDING DIVISION #: PLM2005 0051
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/8 /2006
Phone: (503) 639 -4171 N ' �
I nspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/1712005 TIME: 7:06AM PAGE: 74
• SITE ADDRESS: 15316 SW GREENFIELD DR CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 026 TYPE OF USE:
PROJECT NAME: SUMMIT RIDGE
DESCRIPTION: Installation of backflow device.
OWNER: DON MORISSEfTE COMMUNITIES LLC, PHONE #: 503- 387 -7538 •
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5945
Inspection Request Scheduled For: Date: 7/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 011188 -01 503-692-5945 N
Corrections /Comments/ Instructions:
•
•
'vf
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspectorr� o , Date: 7 7/� s �T Phone #: (503) 718-