Permit a CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00300
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/16/2008
PARCEL: 1S134DB-12000
SITE ADDRESS: 11034 SW NORTH DAKOTA ST ZONING: R-4.5
SUBDIVISION: DAKOTA GLEN LOT: 022 JURISDICTION: TIG
PROJECT: DAKOTA GLEN
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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 Description Date Amount
11034 SW NORTH DAKOTA ST
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 7/16/2008 $36.25
[TAX] 12% State Surch 7/16/2008 $4.35
Phone : 503- 387 -7538 Total $40.60
Contractor:
LANDSCAPE OREGON, INC.
12200
UAL A TIN, OR 97062 IN MYSL RD.
TUAL 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 Permittee Signatures y",.�
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.
.4 - - •
• - -Plumbine Permit Application
Building Fixtures cOeS) / FOR OFFICE USE ONLY
City of Tigard iis. _ Received . . . . , jiliros Permit No.: ,,'
„MA Datel3v: 3CIC)
q 13125 SW Hall Blvd., Tigard, OR 97 Plan Review
: ri • Phone: 503.639.4171 Fax: 503.598.1960 A. v Other Permit No.:
Inspection Line: 503.639.4175 0\' DamoBy:
TIGARD esteady
.7urir ' El See Page 2 for
Internet: www.tigard-orgov 1\4 -,layo:d.
aim' . Supplemental Information
;1 ..--•,- ,V _::': ., -, ;t'. OtWORiEr::: :' ' '. . '.-'; - - GR,11-::-Y ' : 'i ::.i.: .,... , -;-',.:. ''•=--', ';'. 'i ; .:t* i •-7,YT.!,
X ew construction El D . I .. ! For special Information use checklist.
- Description I Qty. I Ea. I Total
0 Addition/alteration/replacentent ID Other:
New 1- 2-family dwellings (includes 100 ff. for each utility connection)
- - :•••= -..,--"•- ' 'i-', ' • • ;-'CATEGORY: OF CONSTRUCTION' :!-; ''• ': - '' 1:-- SFR (1) bath 249.20
and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi-famity SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
Fire sprinIder ( sq. fl.) Page 2
: $.: : :: "T sift= i4iiiiikAlieik,Ab T'LoCknoi■i:r•rrqi:L...:
Job site address: j/C)3 I\) DYhi j) Ctieetric.., Catch basin or area drain 16.60 I
City/State/ZIP: Tie a d_ 4 0&, 9-) 7___a3 Drywell, leach line, or trench drain 16.60 '
Suite/bldg./apt no.: Project namebe;Vecitt4 ( 0-)--- Footing drain (no. linear ft.: _•_) • Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Lo S : -
Rain drain connector 16.60
Sanitary sewer (no. linear ft: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: bet_,KC) f. 6_,..- / (.._"_, I Lot no.: 0.--.7)----, Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.: 6..,s - c3
Absorption valve 16.60
Sackflowpreventer x Page 2 1
Landscape Irrigation Bacldlow Device Backwater valve 16.60
-
Clothes washer 16.60
Dishwasher 16.60
16.60
‘i :;..I... 'Nr: ,'J'.i,:i uf;TE1 '4 -:--'• D . :inking fbuntaill
16.60 •
Name: Stone Bridge Homes LLC .
Expansion tank 16.60
Address: 16869 SW 65 Ave 8505
Fixtaresewer cap
16.60
City/State/ZIP: Lake Oswego, OR 97035 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal
16.60
- - - - - • - - --- - - ,..,-.--. •-•:.„:_; __,....:..,.„ ,_ Hose bib 16.60
- 4' -41 q ''''''' ticAPPLICANTti44 • ._ , .:t... - (.;ONTACM.PERSUN. Ice maker 16.60
Business name: Landscape Oregon, Inc
interceptor/grease crap 16.60
Contact name: Ellen Sparrow
Medical gas (value: $ ) Page 2
Address: 12200 SW Myslony Road Primer 16.60 •
City/State/ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Sink/basin/lavatory . , 16.60
Phone: (503) 692-5945 I Fax: : (503-) 692-0768
Tub/shower/shower pan 16.60
E-mail: ellen@landscapeoregon.com
Urinal 16.60
4 1P0, -. 111F4:0titt;'''irhi;;I: : :U ; ,14.1 - . . : T -t2 w„ closet 16.60
Business name: Landscaper Oregon, Inc Water heater ' 16.60
Address: 12200 SW Myslony Road Other: I
City/State/ZEP: Tualatin, OR 97062
Minimum Subtotal
M mum permit fee: $72.50
36.25
Phone: (503) 692-5945 Fax: (503-) 692-5945 Residential bacidlow minimum permit fee: S36.25
CCB Lie.: 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) 4.35
Authorized signature:
TOTAL PERMIT FEE 40.60
Print name: Ellen Sparrow Date: 7 /40 -qe This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
1:1BuDding‘Perrnhe.PLMF-PermitApp doc L2/27/06 44046 167(10102/COWWED)
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CITY F TIGARD 1
O - t-
BUILDING DIVISION PERMIT #: PLM2008.00300
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/2008
Phone: (503) 639- 4171 %����
Inspection Requests (24 Hrs.): (503) 639 -4175 4 :_..
INSPECTION WORKSHEET FOR DATE: 7/24/2008 TIME: 7 :00AM PAGE: 3
SITE ADDRESS: 11034 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 022 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Installing backflow preventer.
OWNER: DON MORISSETTE HOMES INC, PHONE #: 503387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692 -5945
Inspection Request Scheduled For: Date: 7/24/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073168 01 503-692-5945 N
Corrections/Comments/Instructions: 0° ,�
1 7 Flo . YJ-�., G 4r — - Se 2 o �--�—,,,L,A
C a f cb)-- jit
•
NI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: fV►-A-- 1 k" „ Date: 7 1 l n47 Phone #: (503) 718-
,