Permit CITY TIGARD PLUMBING PERMIT
III DEVELOPMENT SERVICES PERMIT #: PLM2006 -00440
I DATE ISSUED: 9/22/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134DB -DGOOB
SITE ADDRESS: SW NO ADDRESS TRACT "B" ZONING: R -4.5
SUBDIVISION: DAKOTA GLEN LOT: 00B JURISDICTION: TIG
Project Description: Backflow device for irrigation. Playground park area. See attached map.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: UNK 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 9/22/2006 $36.25
[TAX] 8% State Surcha 9/22/2006 $2.90
Phone : 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: U, 16 Permittee Signature:
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 -
Plumbing Permit Application �® FOR OFFICE USE ONLY
City of Tigard V \ - ,r
Received n _
2 Data +By:9 Permit NOT \` ! nit V O
13125 SW Hall Blvd., Tigard, OR 972232,V3 �' Plan Review tJ ) 1 U C/ l! T /
Phone: 503.639.4171 Fax: 503.598.1960 9 P /, jt' Other Permit No.:
1' �l Date/13y:
24 Hour Inspection Line: 503.639.4175 ,ri w∎ 1 iG v � � { is1,�_ y J,1' *6 D a t e R ea d +d ru ns:
Internet: www.ci.tigard.or. us (T D� y Y: See Page 2 nr
VA th " Notified/Method: -r S Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description J Qty. J Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 Ii. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
building SFR (3) bath 399.00
❑ Accessory g ❑ Multi- family
❑ Master builder Each additional bath/kitchen 45.00
® O ther: P layground Park
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities
Job site address: Dakota Glen (SW North Dakota Street & SW 110 Place Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: I Project name: Dakota Glen Tract A & B Footing drain (no. linear ft.: ) _ Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: SW Bull Mtn Road
Manholes 16.60
Rain drain connector 16.60
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Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R.: ) Page 2
Subdivision: Dakota Glen I Lot no.: Water service (no. linear tt.: ) Page 2
Fixture or item
Tax map /parcel no.: 655 D2
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2 fir], SG
Landscape Backflow Device for playground park area - See Map Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Don Morissette Homes Expansion tank 16.60
Address: 4230 SW Galewood 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 1 6.60
Business name: Landscape Oregon, Inc.
Interceptorigrease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: S _ ) Page 2
Address: 12200 SW Myslony Street Primer 16.60
City / State/ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Phone: (503) 692 -5945 Fax: : (503) 692 -0768
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Landscape Oregon, Inc. Water heater 16.60
Address: 12200 SW Myslony Street Other:
City/State/ZIP: Tualatin, OR 97062 Subtotal
Minimum permit fee: $72.50
Phone: (S03 -) 692 -5945 Fax: (503) 692 -0768 Residential backtlow minimum permit fee: $36.25 ° - as
CCB Lic.: 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) a , 90
Authorized signature: / -- /} �� TOTAL PERMIT FEE act / S"
Print name: Ellen Sparrow Date: 9/22/06 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:.nuildingWcrmit \PLM- PermitApp.duc 06 %05 440- 4616T(10/02 /COMM't:n)
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BUILDING DIVISION . PERMIT #: PU/12006-00440
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2��ODG
Phone: (503) 639-4171 .
Inspection Requests �4Hroj: (503) 639-4175
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INSPECTION WORKSHEET FOR DATE: 103/2006 TIME: 7:06Alvl PAGE: 81
SITE ADDRESS: SW NO ADDRESS TRAT 0B" CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: DOB TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Backflow device for irrigation. Playground park area. See attached map.
OWNER: DON m1QR}SSE\\E HOMES, |NC.^ PHONE #:
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-592-5946
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Inspection Request Scheduled For: Date: 10/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 03T510-01 503692-5946 N
Corrections/Comments/Instructions:
/ /
/.
,
Y . L . P2 0 ,■SS PARTIAL APPROVAL | I CANCEL I I NO ACCESS
FAIL I I CALL FOR INSPECTION | | ADDITIONAL FEES ASSESSED
4L,2‘
) ik Inspector: Oate: ■ l_. Phone #: (503) 718-
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