Permit III CoITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00200
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 1 S 134DB -11300
SITE ADDRESS: 11026 SW BRENDEN LN ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 015 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
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 # : PRl 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.
Issu e . !/ UL , / /. . . L // Permittee Signature: flj)) ) I C. rf]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.
riiac
Plumbin Permit A li at c y FOR OFFICE USE Or LY .
City of Tigard I p AY 1 6 20 Received c /y
V Dak.'By: J/� I * Permit No.: p ,. -51 Orl
13125 SW Hall Blvd., Tigard, OR 97223 Q'j ®�i 1 rl � 1 Plan Review , 1 p
Phone: 503.639.4171 Fax: 503.598.1960 �� t ' i el aq Date gy: Other Permit No.: HST 2bo - - �O
24- Hour Inspection Line: 503.639.4175 B101-01114°1311.. �' ,� I� Date Ready�'Ay: sp'� t In '
" � � Sec Paec 2 for
Internet: www.ci.tigard.or.us Wa fred /Method: l IC� I ® Supplemeolal Information
TYPE OF WORK FEE* , SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration /replacement ❑ Other: New I- 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
SFR (3) bath 399.00
El Accessory building ❑ Multi- family
Each additional bath/kitchen 45.00
❑ Master builder 0 Other: Fire sprinkler ( sq. It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11026 SW Brendcn 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 15 Footing drain (no. linear fl.: ) Page 2
- Manufactured home utilities 114.00
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 It.: .) Page 2
Subdivision: Dakota Glen 1 Lot no.: 15 Water service (no. linear IL: ) Page 2
Fixture or item
Tax map /parcel no.: 655 C3
Absorption valve 16.60
DESCRIPTION OF WORK Backtlow preventer ( Page 2 �-'7 - Cs
Landscape Backilow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
® PROPERTY OWNER I El TENANT Eicctors/sump 16.60
Name: Don Morissette Homes Expansion tank 16.60
Address: 4230 SW Galcwood Fixture /sewer cap 16.60
City /State/ZIP: Lake Oswego, OR 97034 Floor drain /floor sink/hub 1 6.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
® APPLICANT ® CONTACT PERSON .
tee 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/basinilavatoly 16.60
Phone: (503) 692 -5945 Fax: : (503) 692 -0768
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.
Subtotal
City /State /ZIP: Tualatin, OR 97062 Minimum permit fee: $72.50
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 Residential backflow minimum permit fee: S36.25 3(. `�S
C Plan review (25% of permnt fee)
CB Lic.: 7804 Plumbing Lic. no.:
State surcharge (8% of permit tee) ca - 6
Authorized signature �C *''� � TOTAL PERMIT FF.F 39 , / S
Print name: Ellen Sparrow Date: 05/16;07 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fcc methodology set by Id-County Building Industry Scrvicc Board.
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CITY OF TIGARD
BUILDING DIVISION 1 PERMIT #: PLM2007-00200
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/17/2007
Phone: (503) 639-4171 IL
Inspection Requests (24 Hrs.): (503) 639-4175 sAIW
INSPECTION WORKSHEET FOR DATE: 6/26/2007 TIME: 7:01AM PAGE: 51
SITE ADDRESS: 11026 SW BRENDEN LN CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 015 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Landscape backflow device.
OWNER: DON MORISSE1TE HOMES, , PHONE #: 503-3874538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 603-692-5945
Inspection Request Scheduled For: Date: 6/25/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 060826-01 603-692-6945
Corrections/Comments/Instructions:
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PARTIAL APPROVAL fl CANCEL fl NO ACCESS
I I FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date:UO Phone #: (503) 718-