Permit ,R
C ITY OF TIGARD PLUMBING PERMIT
,,,; iA, DEVELOPMENT SERVICES PERMIT #: PLM2006 -10004
' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/31/2006
PARCEL: 2S 109DA -03400
SITE ADDRESS: 15393 SW GREENFIELD DR ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT: 011 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 3/31/2006 $36.25
[TAX] 8% State Surcha 3/31/2006 $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: a)--■
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.
I Unding' Fixtures
Plumbing Perm �4 ^ 4• EVED . FOR OFFICE USE ONLY
City of Tigard Receive 3. / _ - ,
13125 SW Hall Blvd., Tigard, OR 9 ? Pla R Permit N. ip A)_ 1D�L /
Phone: 503.639.4171 Fax: 503.59 11114 0 2006 A Plan Review �/ T
24- Hour Inspection Line: 503.639.4175 "� ' l' ' ' � ' ' + A Date/By: : Other Permit No.:
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8 ,. - Supplemental See Page for
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New construction ❑ Demolition For special information use checklist.
❑ Addition/alteration/replacement Description 1 Qty. � Ea. I Total
❑ Other:
r ; ,?� y ,.• r i -,, �, Pl - k New 1- 2- family dwellings (includes h. for each utility connection)
j� .- •• 7 ., r • a • rt, >%..,.. {. „ :. 100 onnac❑ )
_.' -a t:i -: sue, ta : . EG - :� N''' ' i . e s 4t6 .
` ° 't j :1't " r 5 ,'" t ' i :"� c
a . tih::aax' « SFR (1) bath 249.20
kg 1- 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:
[ Sa, slf�lfl� r t�dz• '' -• ' Lr i .'b Y ;`. + •rs . rp, v Fires sprinkler itt
11� / •-; + > Y f Qji f ' - 4;
,r �q P ( sq. ft.) Page 2
-... •31U. iiis ✓l g,?i �`, i P V' i L l a ��1 � ` '.1 ' 1 . 2 . . G. �h, .1
Job site address: ) c: Site utilities
3 l ,S- LC c ', C r 7 ,_t a Dx..... Catch basin or area drain
e3 ( 0 16.60
City /State/ZIP:
! a 0 4) a. y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project narn4y- (.•L.}rylal (•I- r✓ Call / Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
Z. 14-0 - Manholes 16.60
L�' �) � f ,, -e El.c c
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
-
Subdivision: S L LTV) ret L{ C) Water service (no. linear ft.:
/'LL d 9 C ' Lot no.: ! /
( ) Page 2
Tax map /parcel no.: ( c. fi r Fixture or item
.L' S
'ti, F 'F ,:.,,; `_` ' r ... ,a6.17. Absorption valve 16.60
.,., k < , : ir,�: ', ;. : W 1P � , 1 : : ::St '
'. 1r� ;frt ,..ry A . .5..._.�v .., • . ...,.. •Y'S ;i: i'r +.'A: ,n £' b 3 K".t "�.� i f'i` .
, ,.. ° c.w r �r,�„f,[::.i;x[:,.:ii ' ': �,.::....; ';i:,.�,c„ c ,,■ Backflow preventer Pa e 2
/ � !� / / . Backwater valve 16.60 � g � r l . J.S
l-""t)"1 SC &i)( -: i r ✓ 1 l/// ;' if f1G-C- 162( d 6t; /e,e
f Clothes washer 16.60
' Dishwasher 16.60
k�y . ;';ic' T Y'r(7 . ' %a= '' , i .,, � ..,,: : .r: .u, :a ; e•:. , Drinking f 16.60
'S., .''f �':i �.3 � . .. lu�'�� '�.+ `; >' �'.� : aR' 1 }x'0` ,i t ^iNIAd�
' Ejectors/sump 16.60
Name: b e -- k) Y)06 7 .'> .s r- . . L + S e ar
Address: ��n 4 i7f-S LLB Expansion tank 16.60
��30 S L C� � , : (t e t_ ?p 0c
L Fixture /sewer cap 16.60
City /State/ZIP: L el. /< C C) .S i-& j , e• y 0i / '703 3 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
-
;a ;jam" pq i;w.` ti ' +- .� � .., r., i,t ^i,' :i;9 '` u• ,i_ ,. �,yi sy. ' vita, ,,,T'
� ,N i tt i; ,,6k /S s 1 `44 1 f 4 . . Hose bib 16.60
W s}T,: Y, a•..a.. ,:.0 =• 'i! ; „ + :, ?., <," : �sr. � : R. ,..,44., u4� ;> ,
lee maker
Business name: (T)' L , � G 16.60
�r l� rC/ 0,5„-e Interceptor /grease trap 16.60
Contact name: C- W �r M;, / i 6,Li✓ Medical gas (value: $ ) Page 2
Address: 1 a - ei O ., ID /Y id C / IWI t,i (Z,D Primer 16.60
I
City/State /ZIP: T 1 (,(l u 0 ( 2_ , J e j 76 to Roof drain (commercial) 16.60
Phone: (56 (G 9 - J /V S Fax: : (5 3) 6 F ,q _ 6 ' &, ✓ Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
��x 16.b
a ..,,,;4,,,,,,,,,, , iiySi° :1r . ... -, ,: a . ; {t.. s y ,., ::> : r. ^,: Urinal 0
, a_ , ytf6 _Jt<i4 /CQN C'l',O rr'. • `';:' . M -:: ;. , } '
/ ^ � : r <r.�Aa:... d!v: :. .,. ;;;� .�1.-- ,�!6;w Water closet 1660
Business namee tzt4 S eu.6 G O y� - ',.../.7 ( Water heater 16.60
Address: / a3 C , y, J co U. / f / R.....0 Other:
i uy;statcr�IP: `• )� y� f7000
/ �- - - - - - Subtotal
Phone: 3) lOYo S C�t�S [[JJ F ax: ( 5O3) / /� �1 Minimum permit fee: $72.50
l lD7oC - 07 C g " Residential backflow minimum permit fee: $36.25 3 (.P • -S
CCB Lic.: 7 � (�
, % [ pin umbing Lie. no.: Plan review (25% of permit fee)
Authorized sign� -'4 C tate surcharge (8% of permit fee) l , y 0
, Si J� TOTAL PERMIT FEE
- 'CGl� Dat9'/ 3 3/,
Print nameg`/ en
/' �� 3 � (?�D This p application expires if a permit is not obtained „ itbin
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
tonuiidingtPermitsT[.tvrp- PermitApp dr 12 /03 440.46167(10 /02/COM/wEB)
T•d 99L0- 269 -EOS u eE2 =LD 90 TO JeW
C O T "L-
BUILDING DIVISION PERMIT #: Z 0G , 6, - / d 60
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /oi� u � alb
Inspection Requests (24 Hrs.): (503) 639 -4175 -'I ..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
i
SITE ADDRESS: J 3 � 3 r." CLASS OF WORK:
SUBDIVISION: / LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 Z — O(e Pour Time:
Code # Inspection Description Confirm # Contact # Message
39 9 :
i.....vv.L .-.-.1.--j-Nes,-\ (0 9— s -q ef�s
Corrections /Comments /Instruction
•
I ii9a,..-717.---. -
/ ' / L.. J V a i < Avalc,L...
■
4---PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Ins ector: Date: l/ Phone #: (503) 718 -