Permit C ITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2006 - 00530
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/1/2006
PARCEL: 1 S134DB -11100
SITE ADDRESS: 11330 SW 110TH PL ZONING: R-4.5
SUBDIVISION: DAKOTA GLEN LOT: 013 JURISDICTION: TIG
Project Description: Residential backflow preventer 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 -
4230 GALEWOOD ST # 100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 11/1/2006 $36.25
[TAX] 8% State Surcha 11/1/2006 $2.90
Reversal - [PLUMB] Pe 11/1/2006 - $36.25
Phone : 503 - 387 -7538 Reversal - [TAX] 8% St 11/1/2006 - $2.90
[PLUMB] Permit Fee 11/1/2006 $36.25
Contractor: [TAX] 8% State Surcha 11/1/2006 $2.90
LANDSCAPE OREGON, INC. Total $39.15
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Backflow Test
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 Signature:
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.
P Jnmi1k& i 1 Ar pv 1 at 1 , , 1
Plumbing Permit Application FOR OFFICE USE ONLY
an
City of Ti g d R eceived
`� Date /By: Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 // re+ nt 1 ir Date /By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ,.
p __.. Date Ready /By: lads: Se Page 2 for
Internet: www.ci.tigard.or.us Notified /Method: I � Supplemental Information
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® New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
g ., -;.:mod .» �.. -. c-- :�.= ,x�Wa'e:�' 'p.,m
11 ...,, d v :U,4,1i 3 ��z,n .;"< : t .'. ;.
;:sir =.Fr �,'" s �� � � s�.r= �_tW =,= SFR (1 bash 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 1 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
s:, *, Fire sprinkler ( s ft. Pa
: gi p_; G' ) e 2 g
�� , �,_ � , � " , - 4:: Site utilities
Job site address: , i 7 .- ) . [J Catch basin or area drain 16.60
City /State/ZIP: Tigard, OR // D $ iaL.. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
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 1 Lot no.: 1-o Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no
t , �. 120:6W---'4', �� „ , �` Absorption valve 16.60
-. : >,,- -::� _.,,,k -�;w • ,,.�,. ,.. -° • ,., , b ackflow prevemer Page t
Backwater valve 16.60
Clothes washer I 16.60
Dishwasher I 16.60
1�- � � Drinking fountain 16.60
-rte ,_ .".- :, - ,';�� - __. _ Ejectors /sump 16.60
Name: Don Morissette Homes
Expansion tank 16.60
Address: 4230 Galewood St., Suite 100 Fixture /sewer cap 16.60
City/State /ZIP: Lake Oswego, OR 97035 Floor drain /floor sink/hub 16.60
Phone: (503)387 -7538 Fax: (503)387 -7615 Garbage disposal ( 16.60
k ;51. � , ,, , - �WPri p a. . 1, ,as._,. Hose bib 2, 16.60
' " �� � "�' *„ Ice maker I 16.60
Business name: Don Morissette Homes
Interceptor /grease trap 16.60
Contact name: Tiffany Lane Medical gas (value: $ ) Page 2
Address: 4230 Galewood St., Suite 100 Primer 16.60
City /State /ZIP: Lake Oswego, OR 97035 Roof drain (commercial) 16.60
Phone: (503) 387 -7538 I Fax: : (503) 387 -7615 Sink/basin/lavatory 16.60
Tub /shower /shower pan '1 16.60
E -mail: tlane @donmorissettehomes.com
::y ". ; ,s �
; ;.. Urinal 16.60
.
J� = fp4,0: :,,,,,' Water closet .5 16.60
Business name: Harry & Son Plumbing Water heater ) 16.60
Address: 7117 N Armour Other:
City /State /ZIP: Portland, OR 97203 Subtotal
Minimum permit fee: $72.50
Phone: (503) 286 -2822 Fax: ( ) O ' Residential backflow minimum permit fee: $36.25
CCB Lic.: 68900 Plumbing Lic. no.: 26 -448PB Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 7 2-„_�
TOTAL PERMIT FEE
Print name: Harry Peterson Date: ?5/ 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.
i:\ Building \Permits\t'LM- Pennit App. doc 12/03 440 -4616T(t0 /02 /COM/WEB)
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• ®
•
• .- MEMORANDUM
TIGARD
TO: Distribution List
FROM: Bethany Stewart
RE: ADDRESS CLARIFICATION DAKOTA GLEN
DATE: 11/28/06
This memo is to clarify that lots 13 (WCTM 1 S134DB- 11100) and 14
(WCTM1S134DB- 11200) are located off of 110 Place not Torland Street.
Please verify the addresses are listed in your information as:
11330 SW 110 Place, Tigard, OR 97223 - for lot 13, parcel 1 S134DB -11100
11326 SW 110 Place, Tigard, OR 97223 — for lot 14, parcel 1S134DB-11200
I've attached a map for reference. If you have any questions, please contact me
at 503 - 718 -2459 or bethany @tigard- or.gov.
Thank you.
Oct 31 06 10:30a Ellen 503 - 692 -0768 p.2
. -
.may �;
Plumbing Permit Application FOR OFFICE USE ONLY A City of Tigard ED DatcReceiveiBy: d
�D �/ D � ,,,
Permit No.: ,G.//c -eo.
13125 SW Hall Blvd., Tigard, OR 97 p
� �ZLiu
Plan Review '
Phone: 503.639.4171 Fax: 503.598. 9. c i .
p C 1 3 2000fujlll., Date /By: Other Permit No.:
24 Hour Inspection Line: 503.639.417 O a
Internet: www.ci.tigard.or.us ^r -. Date Ready/By: tom @e
r �;;e Q Notified /Method: lC rJ , Supple mental lnformation for
TYPE - mJiSION FEE* SCHEDULE
® New construction BU`LD
ID Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
❑ Addition/alteration / replacement 11I Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249,20
® I- and 2- family dwelling LI 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: 11330 SW rsee.-
�Q(,9/ 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.: I Project name: Dakota Glen 13 Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: SW North Dakota Street Manufactured home utilities 110.00
Manholes 16.60
. Rain drain connector 16.60
Sanitary sewer (no. linear It.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Dakota Glen Lot no.: 13 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: 655 C 2 Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Backtlow preventer / /
Page 2 ,,,I._7, 55
Landscape Backtlow 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 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
fee 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
Phone: (503) 692 -5945 I Sink/basin/lavatory 16.60
( ) Fax: (503) 692 -0768
E -mail.
Tub /shower /shower pan 16.60
Urinal 1 6.60
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 tee: $72.50
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 Residential backilow minimum permit fee: $36.25 310 ,r--
CCB Lie.: 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: Q/�
State surcharge (8% of permit fee) iP, , `X)
‘...1,t, TOTAL PERMIT FEE 1, /
Print name: Ellen Sparrow Date: 10/31/06 This permit application expires if a permit is not obtained within
ISO days after it has been accepted as complete.
*Fee methodology sct by Tri- County Building Industry Service Board.
I °. Building Terrnits PermitApp.doc 06 :05 440- 4616r(10/021COIWWEB)
r" ,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200&00 30
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/1/2006
Ph (503) 639 -4171
A 1p� pI�41 ..
r Inspection Requests (24 Hrs.): (503) 639 -4175 144-• °'_..
INSPECTION WORKSHEET FOR DATE: 11/16/2006 „TIME: " 7:00AM PAGE: . 63.
SITE ADDRESS: 11330 SW CST , ��,,,,, Y'' 'CLASS OF WORK: ,r.0,'
SUBDIVISION: DAKOTA GLEN N iii LOT #: 0 TYPE OF USE: s " ' CO,
PROJECT NAME: �" c`
DAKOTA GLEN It,
DESCRIPTION: Residential backflow preventer for irrigation. . �`
a � .
OWNER: DON MORISSEi tE HOMES, t y. PHONE #: 503- 307 -7538 -
CONTRACTOR: LANDSCAPE OREGON, INC. 'PHONE #: 503. 692 -5945 . ,
T ry
ft, Inspection Request Scheduled For: Date: . Pour Time::
p q 111?i6} Ot�6 ' '�t • 44' �`
Code # Inspection Description Confirm # Contact # . ; ; Message ,41 f= '' .
399 Plumbing final 0398440/ 603 - 692 -5945 N , d i:; , :v1,41, ,. .
Corrections /Comments /Instructions: '` � , • €i ` t'
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V 1 PASS PARTIAL APPROVAL n CANCEL I I NO ACCESS
11 k IL [l CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Date: rl 14 a Phone #: (503) 718 -1-61/X