Permit pp! CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00201
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 1 S134DB -11600
SITE ADDRESS: 11053 SW BRENDEN LN ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 018 JURISDICTION: TIG
PROJECT: DAKOTA GLEN
Project Description: Landscape 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 HOMES, INC
4230 GALEWOOD ST., STE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 5/17/2007 $36.25
[TAX] 8% State Surcha 5/17/2007 $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 B J Lim ' 1 y Permittee Signature: Sj�P4 /+ dJ I; 01.1701
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.
Illii
Plumbing Permit App ation. FOR OFFICE USE ONLY
City of Tigard 0 �oo r1 � Received
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7
13125 SW Hall Blvd., Tigard, OR 97223 „ (1v�tw� I A Permit Nc : M f. - 1J •
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Phone: 503.639.4171 Fax: 503.595.196Gt��o' `� figs “ Date /By: `� I ?y Plan Revie v wail Dare /By: Oilier Pennit No.: t l�r9 J 0 --00,6!
24- Hour Inspection Line: 503.639,4175Bt_��`� a. . ,•'` I Date ReadyBy: J.' r ri See Page 2 for
lea •
Internet: www.ei.tigard.or.ua NotificdMcthed: ('f Supplemental lnformation
TYPE OF WORK • ., FEE* SCHEDULE
® New construction ❑ Demolition For.rpecial information use checklist
Description I Qty. I Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ti. far each utility cannection)
CATEGORY OF CONSTRUCTION SFR(1) bath 249.20
® 1- and 2- family dwelling ['Commercial/industrial SFR (2) bath 350.00
CI Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
lob site address: 11053 SW Breeden Lane 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.: Project name: Dakota Glen 18 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: SW North Dakta Street
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Dakota Glen Lot no.: 18 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: 655 C3
Absorption valve 16.60
DESCRIPTION OF WORK Backlluw preventer / Page 2 � -7 , �
Landscape Backflow Device Backwater salve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I
Drinking fountain 16.60
1:3 TENANT
Ejwtors/aump 1 6.60
Name: Don Morissette Homes Expansion tank 16.60
Address: 4230 SW Galewood Fixture /sewer cap 16.60
CityiState /ZIP: Lake Oswego, OR 97034 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.69
Hose bib 16.60
® APPLICANT ® CONTACT PERSON
Ice maker 16.60
Business name: Landscape Oregon, Inc. Interceptor/grease 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
Sink,basin•'lavatoly 16.60
Phone: (503) 692 -5945 Fax: : (503) 692 -0768 16.60
Tub /shower /shower pan
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:
Subtotal
City/State /Z1F: Tualatin, OR 97062 Minimum permit fee: $ 72.54
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 Residential hackfow minimum permit fee: $36.25 01,
Plu1nbing Lic. no.: Plan review (25% of permit fee)
CCB Lie.: 7804
State surcharge (8% of permit fee) ;2, /
Authorized signatur .e,r) _ (�j J.� - , 4)- it e TO'T'AL PERMIT FEE .39, 7Z
Print mime: Ellen Sparrow r Date: 05/16/07 This permit application expires if a permit is not obtained within
_ 180 days after it has been accepted ss complete.
"Fee methodology set by Tri- County Building Industry Service Board.
is Tsui !di . rmrcs,PLM- PerrnttApp.auc (16005 440-46 1 71YIOmJCo:wwEB)
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00201
13125 SW Hall Blvd., Tigard, OR 97223 `` DATE ISSUED: 5/17/2007
Phone: (503) 639- 4171 �ud��4ju�� "��I
Inspection Requests (24 Hrs.): (503) 639 -4175 Aa./.
INSPECTION WORKSHEET FOR DATE: 6/1/2007 TIME: 7:02AM PAGE: 3
SITE ADDRESS: 11053 SW BRENDEN LN CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: • 018 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Landscape backflow device.
OWNER: DON MORISSETTE HOMES, INC, PHONE #: 503.3137 -7536
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503. 6915945
Inspection Request Scheduled For: Date: 611/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 049433.01 503.692 -5945 N
Corrections /Comments /Instructions:
•
PASS n PARTIAL APPROVAL I CANCEL n NO ACCESS
I I I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: PI l Ve- Date: Phone #: (503) 718-
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