Permit IN CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00301
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/16/2008
PARCEL: 1 S134DB - 11900
SITE ADDRESS: 11046 SW NORTH DAKOTA ST ZONING: R-4.5
SUBDIVISION: DAKOTA GLEN LOT: 021 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
4230 GALEWOOD ST, STE 100
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 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 ._ ` ___ ` 1 f Permittee Signature: ese ,�7� c �✓
4' '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.
•
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_. . . ..
inabine Permit Application
Building Fixtures
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FOR OFFICE USE ONLY
. City of Tigard
, . . 13125 SW Hall Blvd., Tigard, OR 97223
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of - 577 -Pcnn " °.: l
ts4 • . Review
• 1 • Phone: 501639.4171 Fax: 503.598.1960 Oi ' Date/Br Other Permit No.://
Inspection Line: 503.69.4175
TIGARD 6c Datr Read y/Ely: hlds: El See Page 2 for
Internet: 1.vww.ti 3 gard-orgov
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0 New construction 0 Demolition For special information use checklist
Description I Qty. _I Ea. I Total
0 Addition/alteration/replacement 0 Other. New 1-2-family dwellings (includes 100 R. for each utility connection)
'...-: ---'•-• -r '• . .Z .I ''' .' i t H .*-.. tATE60Ftir O17: etrikiittilecik " ' ' - '''' '"--'" ''''
1 • ,..• , i , : . ,...., ..:, 4 -....,_... „ :.__ ,..„........._..:::.,,,, ,. ;::;i,::::!! SFR ( bath 24920
CI 1 - and 2 dwelling CI Commercial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder 0 Other . , .. . Fire sprinkler ( sq. f t . ) 1 Page 2
..ibi S ITE isiiiiiiiiitai4;Iiii ' ' ' k - . ,': '--"-. • '''
Job site address j / 0 c A joy- 17)0_.j4o1.-6(_. Catch basin or area drain I 16.60
City/State/ZIP: nIZI,•1 6L - 0 ) q ) '2 - (D...? Dtywell, leach line, or trench drain : 16.60
Suite/bldg./apt. no.: Project =MD 0..140 fa_ 6.7ted,1/4_ . Footing drain (no. linear ft.: ___) Page 2
, Manufactured home utilities 110.00
Cross street/directions t/directions to job site:
Manholes 16.60
-S
LL. t.) C YfiI bee---tGc)fr. Si Rain drain connector 16.60
Sanitary sewer (no. linear 1: ) Page 2
_
Storm sewer (no. linear fl.: ) Page 2
:e,1 Water service (no. linear IL: ) Page 2
Subdivision: Lot no. 1
Fixture or item •
Tax map/parcel no.: ( .F.,.., C. 3 . . Absorption valve - 16.60 1 •
' ; , .4f... : If '_ "-::-.:.--. • ' '..i.: ot WORK -T:::!: T -., EL , t- x Page 2 1
Landscape Irrigation Bacidlow Device Backwater valve 16.60 .
Clothes washer 16.60
Dishwasher 16.60
kin_ . Drin g fountain 16.60
iiiciiigc4*.iNik' ......... ..',•-.- :.;:ft : ' t : 16.60
, •
Name: Stone Bridge Homes LLC Expansion tank 16.60
Address: 16869 SW 65 Ave #505 _ Fixture/sewer cap • 16.60
City/State/ZIP: Lake Oswego, OR 97035 Floor drainifloor sinkihub 16.60
Garbage disposal 16.60
Phone: ( )
. - ' Hose bib 16.60
4 .'..;''':-. 4T :' : ,,- .":" ' . 1 ,,, - 1: TY ' cci.rfkr . Y.tii.PN,!i' -,•:- i; , 16.60 • Ice maker
Business name: Landscape Oregon, Inc Interceptor/grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: S ) Page 2
16.60
Address: 12200 SW Myslony Road Primer -
Roof drain (commercial)
16.60
CityiStateJZIT: Tualatin, OR 97062 -
Sink/basin/lavatory 16.60
Phone: (503) 692-5945 I Fax: : (503-) 692-0768
Tub/shower/show _ Tub/shower/shower pan 16.60
E-mail: ellen®landscapeoregmeom
16.60
--=.., - h • - i 4 :-.. '7. 6 7.• - •t;VS, :, ,•3 ....,1.:_-1,
.:.,..:-..,:-...-!...„ -......f.. .,;,....:-.. YIE ',....:.; r ,',:s ' •';!,'. .j-'1:. Water closet 1E60
....: r -.''. J. . 1-3. .a
W ter heater 16.60
Business name: Landscaper Oregon, Inc a
Other
Address: 12200 SW Myslony Road Subtotal •
City/State/ZIP: Tualatin, OR 97062 Minimum permit fee: $72.50 36.25
Residential backflow minimum permit fee: $36.25
Phone: (503) 692-5945 Fax: (503-) 692-5945 Plan review (25% of permit fee)
CCB Lie.: 7804 Plumbing Lic. no.: State surcharge (12% of permit fee) 4.35
TOTAL PRM1T FEE 40.60
Authorized signature:
Print name: Ellen Sparrow 180 days after it bas been accepted as complete.
- ( .. 0 a c7 This permit application expires If a permit is not obtained within
Date:
*Fee methodology set by Tri-County Building bidustry Service Board.
440-4e167(10102.
I,.'d 89L0 ueie e9E:80 80 91, Inr
CITY OF TIGARD r
BUILDING DIVISION y PERMIT #. PI M200 &003111
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 7/16/2008
Phone: (503) 639 -4171 d il
Inspection Requests (24 Hrs.): (503) 639 -4175 ,'!+�
INSPECTION WORKSHEET FOR DATE: 8/4/2008 TIME: 7:03AM PAGE: 21
SITE ADDRESS: 11046 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: Q21 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Installing backflow preventer.
OWNER: DON MORISSETTE HOMES INC., PHONE #: 503 - 3874538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503692 -5945
Inspection Request Scheduled For: Date: 8/4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message •
399 Plumbing final 073662 -01 503 -692 -5945 N
Corrections /Comments /Instructions:
Re (A_ TT 4-4 & e. ie
Ca,f c L
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CR 1 _ l ■ \\ 1/40,....•..... Date: t gl 4 1 OT) Phone #: (503) 718-