Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00274
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/27/2007
PARCEL: 1 S134DB -11800
SITE ADDRESS: 11017 SW BRENDEN LN ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 020 JURISDICTION: TIG
PROJECT: DAKOTA GLEN
Project Description: Install 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 Description Date Amount
4230 GALEWOOD
SUITE 100 [PLUMB] Permit Fee 6/27/2007 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcha 6/27/2007 $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 B Permittee Signature: 1i. Piph(g-f?eri
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 co mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
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Phone: 503.6394171 ax: " 03. l' r ' t Plan Review llr r.4y ! + ` >., ,
24- Hour Inspection Line: 503.639 � V Date Other Permit No.:
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Internet: www.ci.tigard.or.us Y Y ,_...,- Juris g) gee Page 2 for
Notified'Method: 1 Its' s ' Supplemental information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition - For special information use checklist
Description I Qty. I Ea. r Total
❑ 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 i El Mul ti-family SFR(3) bath 399.00
❑ Master builder El other: Each additional bath/ldtchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11017 SW Brenden 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 20 Footing drain (no, linear ft.: ) Page 2
Manufactured home utiliti 110.00
Cross streeti'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.: 20 Water service (no. linear ft.: 1 Page 2
Fixture or item
Tax mapiparcel no.: 655 C3
Absorption valve 16.60
DESCRIPTION OF WORK Backflaw preventer j Page 2
Landscape Back Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
IS PROPERTY OWNER I ❑ 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 l ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Landscape Oregon, Inc. Jntcrceptor. /grease trap ]6.60
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 I Fax:: (503) 692 -0768
Sinkibasin/Iaeatory 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/ZEP: Tualatin, OR 97062 Subtotal
Minimum permit fee: 572.50 t / ,,,,_s____, ,,,,_s____, Phone: (503 -) 692 - 5945 Fax: (503) 692 -0768 Residential backtlow minimum permit fee: 536.25
CCB Lic.: 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
Stale surcharge (8% of permit fee) c7 0
Authorized signature: TOTAL PERM IT FEE S
Print name: Ellen Sparrow Date: 06/26/07 This permit application expires if a permit is not obtained within
IRO days after it has been accepted as complete.
phone: 503.692.5945 • fax: 503.692.0768 • 12200 SW Myste 4111121011ir;10091gartaRatiay Setvioe Board.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PI 00274
13125 SW Hall Blvd., Tigard, OR 97223 ..A DATE ISSUED: 6/27/2007
Phone: (503) 639 -4171 m° Diu' ( ,
Inspection Requests (24 Hrs.): (503) 639 -4175 'AL
INSPECTION WORKSHEET FOR DATE: 6/29/2007 TIME: 7:00AM PAGE: 55
SITE ADDRESS: 1101 7 SW BRENDEN CLASS OF WORK:
LN
SUBDIVISION: DAKOTA GLEN LOT #: 020 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Install landscape backflow device.
OWNER: PHONE #:
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503.692 -5945
Inspection Request Scheduled For: Date: 6/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 051166.01 503- 692 -55945 • N
Corrections /Comments /Instructions:
q /'"
y /
- A S n PARTIAL APPROVAL n CANCEL I I NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V Date: 3' AL Phone #: (503) 718-