Permit �' CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00139
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/10/2007
PARCEL: 1S134DB-10800
SITE ADDRESS: 11392 SW MEGAN TERR ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 010 JURISDICTION: TIG
PROJECT: DAKOTA GLEN
Project Description: Install residential backflow prevention device for irrigation.
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 # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/10/2007 $36.25
[TAX] 8% State Surchart 4/10/2007 $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.
Issu By _ ■ 1_A1 _,1 � ' Permittee Signatu •. / ' i ,• i i i /
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.
d Bonded - Insured •
Plumb; LP9_!;s' -i a..ti s'..t' ' 1 � r' FOR OHI IZG USE ONLY
.. is, C lgar Received ,, / /j) 47 Permit No.: LN� 3 �/
_ 125 SW Hall Blv • :I • �j� Date/By: * Plan Review
Phone: 503.639.417 ax. 5t Y '' • • / w .0 ti std $ ( a�1�`
`�
7 /
e
�' , Date; 13y: Other Permit No.;
, Hour Inspection Line: 503.639.' 175
Internet: CITY ®F • ) :1 I -
Intemet: www.ci.ti ard.or.ue BUILDING , •��` Date R d / See Page 2 for
€ W Votifie3.'Method _ l ap Supplemental Information
TYPE OF WORK FEE'S SCHEDULE
El construction ❑Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
0 Addition/alteration /replacement El Other: New 1- 2- family dwellings (includes 100 II. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
® I- 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
E l Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11392 SW Megan Terrace Catch basin or area drain 16.60
CityiState/ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: I Project name: Dakota Glen 10 Footing drain (no. linear ft.: , ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: SW North Dakota 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 I Lot no.: 10 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: 655 C2
Absorption valve 16.60
DESCRIPTION OF WORK , Backflow preventer / Page 2 , . 7. 5J
Landscape Backflow Device Backwater valve 16.60
Clothes washer 16.60
' Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Don Morissette Homes Expansion tank 16.60
Address: 4230 SW Gralewood Fixturetscwer cap 16.60 1
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 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 /hasin/lavatory 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:
City /State/ZIP: Tualatin, OR 97062 Subtotal
Minimum permit fee: 572.51) _
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 Residential backflow minimum permit fee: S36.25 .t (,. , .S
CCB Lie.: 7804 1 Plumbing Lie. no.: Plan review (25% of permit tee)
•
f:." Slate surcharge (8% of permit fee) C' . C I' 0
Authorized signature C e`t..(-)
TOTAL PERMIT FEE .3'?.. i 5
Print name: Ellen Sparrow ' Date: 04/09;07 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
phone: 503.692.5945 • fax: 503.692.0768 • 12200 SW MySR ryeg .dol y •TaIllrj{a3r1{(}p jip0 y Service Board.
i •• Budding •.Pemiti PamitApt.loe 06105 440- 4616T(1O:O:,COMwlta)
L' 89L0 - 009 u e917:80 LO 60 add
CITY OF TIGARD ,.,
BUILDING • DIVISION PERMIT #: PLM2007-00139
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/10/2007
Phone: (503) 639 -4171 0 4fivip llt
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/11/2007 TIME: 7 :00AM PAGE: 27
SITE ADDRESS: 11392 SW MEGAN TERR CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 010 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Install residential back[low prevention device for irrigation.
OWNER: DON MORI SSEI f E HOMES, INC., PHONE #: 503- 307 -7 :30
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5915
Inspection Request Scheduled For: Date: 4/11/2007 Pour Time:
. Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 046315-01 503-692-5945 N
Corrections /Comments /Instructions:
C J (Z'( )4 t-/-z-7/ 6 '� 1 I
CAACC
'K PASS I I PARTIAL APPROVAL ❑ CANCEL ( I NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: <5 Date: y /0 Phone #: (503) 718 -