Permit CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00174
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/30/2007
PARCEL: 1 S134DB -10400
SITE ADDRESS: 11363 SW MEGAN TERR ZONING: R -4.5
SUBDIVISION: DAKOTA GLEN LOT: 006 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 GLEWOOD ST. STE 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 4/30/2007 $36.25
[TAX] 8% State Surcha 4/30/2007 $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 i // Permittee Signature: SQL / 9 f ion
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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�'lumbi I ..�; : . _ % ,,� :►., ;�irs i,t PR 2 2007 FOR OFFICL. LSE ONLY
CI 1g8Ci C c f/ Ur : Dat Biyvcd : Permit No.: p�� -QQ ig
25 SW Hall Blvd r • Q j •:"'• ( ' ,� Plan Review
Phone: 503.639.41 71 ax: I ' • c 1 w • " x ' - fi wr Other Permit No.: b r �t�2' l0 �
r�l Dale /Ely: runs: MS� L��
24- Hour Inspection Line: 503.639." 75 - EJ� l �
Internet: www_ci.ti ard.or.us N oti fled: Me _ Date ied:Me thod: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description [ Qty. Ea. I 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
1l 1 - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath : 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath j 349.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
S
Job site address: 1136SW Megan Terrace Catch basin or area drain 16.60
Ciry• /State /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite/bld /apt. no.: Project name: Dakota Glen 06 Footing drain (no. linear It.: ) Page 2
g
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 fl.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Dakota Glen I Lot no.: 06 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: 455 C2
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Landscape Backflow Device Backwater valve 16.60
Clothes washer 16.60
• Dishwasher 16.60
Drinking fountain 16.60
® PROPERTY OWNER r CI TENAN[
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 ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Landscape Oregon, Inc. Interceptor,'greasetrap 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 (cornmercial) 16.60
Phone: (503) 692 -5945 I Fax: : (503) 692 - 0768 Sirik'basinllavatary 16.60
Tub /shower /shower pan • 16.60
E -mat 1: Urinal 16.60
CONTRACTOR Water closet i 16.60
Business name: Landscape Oregon, Inc. Water heater 1 16.60
Address: 12200 SW Myslony Street Other.
Subtotal
City /Stale /ZIP: Tualatin, OR 97062 '
Minimum permit fee: 572.50
Phone: (503 -) 692 - 5945 Fax: (503) 692 -0768 Residential backflow minimum 1
m permit fcc: 536.25 - oti..r�
CCB Lie.: 7804 Plumbing Lie, no.: Plan review (25% ol'perrnit lee)
State surcharge (8% of permit fee) t2 9 )
Authorized signature: a,1_ Ld" )
TOTAL PERMIT FEE ,
.37,75
Print name: Ellen Sparrow Date: 04/26/07 This permit application expires if a permit is not obtained within
180 days after it lips been accepted as complete.
phone: 503.692.5945 • fax: 503.692.0768 • 12200 SW My t'1r 19dolog' RI 67611 rY:DE5-%6Iii00111eY S ervice Board -
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00174
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/30/2007
Phone: (503) 639 -4171 i a4p�i �l�l
Inspection Requests (24 Hrs.): (503) 639 -4175 ��' {__..
INSPECTION WORKSHEET FOR DATE: 5/2/2007 TIME: 7:01AM PAGE: 98
SITE ADDRESS: 11363 SW MEGAN TERR CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 006 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Landscape backflow device.
OWNER: DON MORISSE.I tE HOMES INC., PHONE #: 503 -3137 -7531
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 692 - 5945
Inspection Request Scheduled For: Date: 5/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 047435 -01 503.692 -5945 N
Corrections /Comments /Instructions:
PASS PARTIAL APPROVAL Li CANCEL ❑ NO ACCESS
FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (71 w Diu - • Date: S- ) Phone #: (503) 718-