Permit .; CITY OF TIGARD PLUMBING PERMIT
y' CITY PERMIT #: PLM2006 00579
COMMUNITY DEVELOPMENT DATE ISSUED: 12/4/2006
TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S134DB -11500
SITE ADDRESS: 11000 SW BRENDEN LN ZONING: R -4.5
SUBDIVISION: DAKOTA GLEN LOT: 017 JURISDICTION: TIG
Project Description: Baciflow 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 HOMES, INC. Description Date Amount
4230 GALEWOOD ST # 100
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 12/4/2006 $36.25
[TAX] 8% State Surcha 12/4/2006 $2.90
Phone : 503- 387 -7538 - Total $39.15
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS Q
NO
Contact # : PRI 503- 692 -5945 >< "t' r7
FAX 503-692-0768 4 ,+4, Q F.
4.
Reg #: LIC 7804 f
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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: /7 Permittee Signature: r")- a '`-j-ki.
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.
CITY OF TIGARD 0-441■00 00571
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 i E vi i11 414 i1
Inspection Requests (24 Hrs.): (503) 639 -4175 - [ i
INSPECTION WORKSHEET FOR DATE: VI) c/6 TIME: 1 PAGE:
SITE ADDRESS: it 0 01.) &G y1 le..., L bJ. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: L cA 5 ` 6 PHONE #: PHONE #: � _CONTRACTOR: � J (44
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corre ions /Comments /Instructions:
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PASS I I PARTIAL APPR VAL 0 CANCEL 0 NO ACCESS
P r■AIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASS St D
Inspector: r W LA Date: 7/ 6 Phone #: (503) 718 - 2),‘L
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2008 RESIDENTIAL BACKFLOW ASSEMBLY TESTER LIST
t' Updated February 5, 2008
Dear Water Customer:
For your convenience, a list of certified backflow assembly testers working within Tigard Water Service Area is provided below. This list is not inclusive.
Testers are private individuals or companies. Testing costs vary, so getting quotes fiom several companies is recommended
COMPANY ADDRESS PHONE NUMBER
A & A DRILLING PO BOX 585, CLACKAMAS (503)284 -3701
ACCURATE BACKFLOW 2715 HARVEST COURT, FOREST GROVE (503)357 -1444
AFP SYSTEMS 19435 SW 129TH, TUALATIN (503)692 -9284
ALL SEASONS BACKFLOW PO BOX 1811, BEAVERTON (503)644 -4913
ALOHA BACKFLOW TESTING 5074 NW STABLE CT, HILLSBORO (503)693 -1720
AMERICAN BACKFLOW SERVICES 5905 N INTERSTATE AVE, PORTLAND (503)289 -1745
AQUA -TECH BACKFLOW SERVICES 14655 NE RUSSELL CT, PORTLAND (503)251 -1683
BACKFLOW PREVENT. DEVICE TEST PO BOX 751, TUALATIN (503)692 -2885
BACKFLOW SERVICES PLUS 17675 SW FARMINGTON RD # 118, BEAVERTON (503)629 -8200
BASIC FIRE PROTECTION, INC 8135 NE MLK JR. BLVD, PORTLAND (503)285 -1855
BEAVERTON PLUMBING, INC 13980 SW TV HWY, BEAVERTON (503)643 -7619
BWE BACKFLOW TESTING 16923 KING RICHARD CT, SHERWOOD (503)625 -4083
CANBY PLUMBING INC. 805 NE 4TH AVE, CANBY (503)266 -2091
CLEARWATER BACKFLOW 717 E BURNSIDE, PORTLAND (503)703 -7821
COLUMBIA CROSS CONNECTION PO BOX 9217, PORTLAND (503)235 -6141
COOKMAN BACKFLOW 17895 NW TILLAMOOK, PORTLAND (503)645 -0296
DENNIS SEVEN DEES LANDSCAPING 7355 SE JOHNSON CREEK BLVD, PORTLAND (503)777 -7777
DON MARTIN PROPERTY MAINT. 2255 SE 73RD, HILLSBORO (971)570 -7630
DRAKE'S 7 DEES, INC. 16519 SW STARK, PORTLAND
(503)256 -2224
FARR BETTER BACKFLOW TESTING PO BOX 389, BORING (503)475 -9080
FIRE EXTINGUISHER SERVICE CTR 3460 SW 209TH AVE, BEAVERTON (503)356 -9445
FITZERALD LANDSCAPING 10835 SW TIGARD ST, TIGARD (503)620 -4761
GARDENVIEW LANDSCAPE IRRIG. 1095 NE CORNELL RD, HILLSBORO (503)693 -6823
GREEN DAY LANDSCAPE, LLC PO BOX 2613, CLACKAMAS (503)658 -2685
HEATH BACKFLOW TESTING PO BOX 1565, SHERWOOD (503)625 -8553
JACK HOWK PLUMBING PO BOX 20698, PORTLAND (503)235 -8784
JANE GANSER & CO. 8960 SW DOLPH ST, PORTLAND (503)247 -9562
KENNEDY PLUMBING, INC 13985 SW FARMINGTON RD, BEAVERTON (503)643 -5535
LANDSCAPE EAST & WEST 8850 SE 76TH DR, PORTLAND (503)256 -5302
LANDSCAPE ENTERPRISE PO BOX 436, WILSONVILLE (503)682 -3343
LANDSCAPE SERVICES CO PO BOX 1623, CLACKAMAS (503)656 -6890
METRO SAFETY & FIRE INC 14324 SE STARK, PORTLAND (503)231 -2999
MP PLUMBING PO BOX 393, CLACKAMAS (503)655 -9161
NW BACKFLOW INSPECTION & TEST PO BOX 1536, HILLSBORO (503)695 -3286
OREGON BACKFLOW TESTING 212 SE 3RD ST, TROUTDALE (503)491 -9402
OREGON IRRIGATION 15916 S AMES ST, OREGON CITY (503)656 -9826
PM BACKFLOW PO BOX 981, WILSONVILLE (503)830 -0171
PROGRASS, INC 29895 SW KINSMAN RD, WILSONVILLE
(800)776 -4727
ROTO ROOTER 25599 SW 95TH AVE STE B, WILSONVILLE (503)682 -9774
Approved Residential Backflow Tester Listing Updated.
Page 1 of 2
2/5/2008 101 pm
1,'
COMPANY _ ADDRESS PHONE NUMBER
SUNRISE LANDSCAPE PO BOX 665, BORING (503)658 -1828
T &R BUILDING SERVICES 6880 ROGUE LN, WILSONVILLE (503)318 -6313
TIMBER VALLEY PLUMBING PO BOX 34, CANBY (503)266 -4300
TOM HEMPEL TESTING 82696 WILSONVILLE RD # 184, WILSONVILLE (503)579 -0923
WATER METRICS 16120 SW 72ND AVE, TIGARD (503)603 -9988
WESTERN STATES FIRE PROTECTION 13896 FIR ST, SUITE B, OREGON CITY (503)657 -5155
WOMACK WATER WORKS, INC PO BOX 608, BEAVERTON (503)643 -0466
A current public list of DHS- Certified Backflow Testers is available at:
http://oregon.gov/DHS/ph/crossconnection/publiclist.shtml
Approved Residential Backflow Tester Listing Updated:
Page 2 of 2 2/5/2008 3:01 pm
.
CITY OF
��om m n�'m TIGARD -
BUILDING DIVISION �--
~~~,"~~~~.,~~" ~~.~.~~~~°.~ PERMIT #: pLM2006'00579
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1214/3006
Phone: (503) 639-4171
Inspection Requests (24Hm.):(503)030'417G °�J�� "�
INSPECTION WORKSHEET FOR DATE: 12/5/2008 TIME: 7 PAGE: 32
SITE ADDRESS: 11000 SW BRENDEN LN CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 017 TYPE OF USE:
PROJECT NAME: DAKOTA @LEN
DESCRIPTION: Bacl0mwpreventmr for irrigation.
OWNER: DON kH0R|SSEi|E HOMES, |NC.. PHONE #: 50.3-3877538
CONTRACTOR: LANDSCAPE OREGON, NC. PHONE #: 505-682-5945
Inspection Request Scheduled For: Date: 12/5V2O06 . Pour Time:
[}ode # Inspection Description Confirm # Contact # Message
399 Plumbing final 040637-01 503-692-5945 N
,
Corrections/Comments/Instructions: ~
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FAIL pi CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
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Inspector: ~ Date: � / Phone #: (503) 718-
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INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: PLM2006 -00579 REQUIRED ON GREEN INSPECTION CARD.
✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By J
BUP - Building Permit ELC.- Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG - Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa/pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar) •
275 Framing MEC - Mechanical Permit
810 MFG - Structure set -up
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
•
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
•
905 Sprinkler underfloor /slab PLM - Plumbing Permit
910 Sprinkler rough -in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test 315 Post/beam plumbing
995 Misc. inspection: 320 Plumbing rough -in
998 Alarm final 322 Shower pan
999 Sprinkler final 330 Water service
335 Rain drain
340 Storm drain 1
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert/catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing X 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
L \Building \Inspection Cards \Forms \ADP - InspCard - Blank.doc 12/09/2005
1 CITY OF T G D PLUMBING PERMIT
=.;
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00579
TIGAR1 j 13125 SW Hall Blvd. Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/4/2006
r.t = °r = =� g PARCEL: 1S134DB -11500
SITE ADDRESS: 11000 SW BRENDEN LN ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 017 JURISDICTION: TIG
Project Description: Baclflow 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 HOMES, INC.
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 12/4/2006 $36.25
[TAX] 8% State Surcha 12/4/2006 $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: ej 1
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.
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h. _/ — ► i : . D E C , ♦t :' 0 G i °I jr JL 2 U T a- 7 r�° °°5 99
25 SW ll Blv; [' I i A I �y ` a i I i ° �'B Other ermit No.:
24 Hour Inspection Line: 503.634. I ?5 fi • :, j `' a ' , , :. Y ryow emd ® See Page 2 for
• Internet: wwa.citigard.or.us ' Edtivtetkod: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
N New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
0 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- and 2 - family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bathikitehen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2 i
JOB SITE INFORMATION AND LOCAT Site utilities
Job site address: 11000 SW Brenden Lane Catch basin or area drain 16.60
City /StateiZlP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite /bldgJapt. no.: I Project name: Dakota Glen 17 Footing drain (no. linear ft: ) Page 2 •
Manufactured home utilities 1 10.00 .
Cross street/directions to job site: SW North Dakota Street
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear It.. ) Page 2
Subdivision: Dakota Glen I Lot no.: 17 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: 655 C 2
Absorption valve 16.60
DESCRIPTION OF WORK Bacl
Backflow preventer i Page 2 -7 . C-,S
Landscape Backflow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENAN'T Drinking fountain 16.60
Ejectorsisump 16.60
Name: Don Morissette Homes Expansion tank 16.60
Address: 4230 SW Calewood Fixture/sewer cap 16.60
City/State /ZIP: Lake Oswego, OR 97034 Floor drain /Floor sink'hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
® APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Landscape Oregon, Inc.
Interceptor; grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: $ ) Page 2
Address: 12200 SW Myslony Street Primer 16.60
City/State /ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Sink/basin/lavalory 16.60
Phone: (503) 692 -5945 Fax: : (503) 692 -0768
Tub /shower/ shower pan 16.60
E -mail: Urinal 1660
CONTRACTOR Water closet 16.60
Business name: Landscape Oregon, Inc. Water heater 16.E+0
Address: 12200 SW Myslony Street Other:
Subtotal
City/State /ZIP: Tualatin, OR 97062 Minimum permit fee: $+2.50
Phone: (503 - 692 - 5945 Fax: (503) 692 -0768 Residential backflow minimum permit fee: S36.25 3 L . Q_S
CCB Lic.: 7804 Plumbing Lic. no.: Plan review (25% of permit fcc)
A7,9 State sun:barge (8% of permit fee) ;,2 • ',cc...)
Authorized signature; �� ��_c -u.) I TOTAL PERMIT FEE j /, /5-- Print name: Ellen Sparrow Date: 12/04/06 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
phone: 503.692.5945 • fcx: 503.692.0768 • 12200 SW MytkgFlspeSlodol•g• i yNa op @gl}n9j1f $Lry service Board,
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CITY OF TIGARD L4-,(
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 uaBgMu411141
Inspection Requests (24 Hrs.): (503) 639- 4175'��
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: L Aac\Arer.s . S CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
w • S 4e S ' PHONE #:
ONTRACTO TOR: d L- 1 PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections/Comments/Instructions: C PLI-47,00(p p� C 1 c 0 b iJ r'CJ" O& Q -A. IN . - 0 0 i 1 "1 S /
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Inspector: Date: Phone #: (503) 718-