Permit CITY F TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Er PERMIT #: PLM2007 -00205
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 1 S134DB -11000
SITE ADDRESS: 11358 SW MEGAN TERR ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 012 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 Description Date Amount
4230 GALEWOOD ST # 100
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 By• j , j � j i I . Permittee Signature: /// Ii`codie"l
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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Plumbing Permit Appli• = � R% FOR OFFICE USE ONLY .
City of Tigard MAY 1 6 200 nat �s,a5 /f OR 5 Permit No.: P -M Zoo c 0205- 13125 SW Hal] Blvd.. Tigard, OR 97223
Plat Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGr ` .1I '� Date/By: Other Permit No.: HST 206(0 - 00232,
24- Hour Inspection Line: 501639.4175 BUILDING DI,--5-.- l y , - Date Ready.(By: .runs a Sec Page 2 for
Internet: www.ci.tigard.or.us NotifiedNlethod: ' Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description I Qty. [ Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 R, 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 bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
• Job site address: 11358 SW Megan Terrace 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 12 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.: 12 Water service (no: linear R.: ) Page 2
Fixture or item
Tax map /parcel no.: 655 C3
Absorption valve 16.60
DESCRIPTION OF WORK • Backflow preventer 1 Page 2 .)_' , SS
Landscape Backflow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER Drinking fountain 16.60
❑ TENANT
' Ejectors /sump 16.60
Name: Don Morissette Homes
Expansion tank 16,60
Address: 4230 SW Galewood Fixture/sewer cap 16.60
City; State /Z1P: Lake Oswego, OR 97034 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( )
Garbage disposal 16.60
I$ APPLICANT E CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Landscape Oregon, Inc.
- Interceptor/grease trap 16.60
Contact name: Ellen Sparrow j Medical gas (value: . (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:
Subtotal
City/State/ZIP: Tualatin, OR 97062
Minimum permit fec: 572.50
Phone: (503 - ) 692 - 5945 Fax: (503) 692 - 0768 Residential hackflow minimum permit fee: 536.25 3c, :
CCB Lic.: 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
��� r State surcharge (8% of permit fee) �. C tv
Authorized signature: f� TOTA1, PERMIT FEE 39 , / s
Print name: Ellen Sparrow ! Date: 05;i6/07 This permit application expires ifs permit is not obtained within
180 days after it has been accepted as complete.
*FCC methodology set by Trid'.ounty Building Industry Scrvicc Board.
iAt iuilding '.PucrnitsTLM- PenniiApp.doc C6i05 440 1616T(10/02 %COMf14 EN
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00205
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/2007
Phone: (503) 639-4171 . lt
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 611/2007 TIME: 7:02AM PAGE:
SITE ADDRESS: 11358 SW MEGAN TERR CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 012 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Landscape backflcw device.
OWNER: DON iviORISSETTE HOMES, PHONE #: 503-387-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 50-692
Inspection Request Scheduled For: Date: 6/1/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 049431-01 503-692-5945
Corrections/Comments/Instructions:
(
13; PA SS I I PARTIAL APPROVAL CANCEL 7 NO ACCESS
FAIL 0 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector:
4 11ii
Date: Phone #: (503) 718-2-44