Permit r
:= CITY OF TIGARD
COMMUNITY DEVELOPMENT PLUMBING PERMIT
PERMIT #: PLM2007 -00067
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/16/2007
PARCEL: 1 S134DB -11200
SITE ADDRESS: 11326 SW 110TH PL ZONING: R -4.5
SUBDIVISION: DAKOTA GLEN LOT: 014 JURISDICTION: TIG
PROJECT: DAKOTA GLEN
Project Description: 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, INC.
4230 GALEWOOD ST #100 Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 2/16/2007 $36.25
[TAX] 8% State Surcha 2/16/2007 $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 By: --. _ Permittee Signature: —2— k ssf
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.
_ • Borded - Insured
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LCB: 7804
PIumbl t ,74, f_£r ozo,j1 s'?'_t- a 7pp F FOR OFFICE. USE ONLY
C lgar�� '! Da t e e�I3y�/6 (� I , -P61-- Pc- iti( 311'cl O t006 !
t25 SW Hall Blv. � Ir a '��s r ' 1 T fl D 2 ' Plan Review )
Phone: 503.639.417 ax: 50 . f' ' •6 *� � ( f .l a Date; B}: Other Permit No.:
C1
24- Hour Inspection Line: 503.639.• 175 Al Sun s: gI See • e2 for
Internet: www.ci.tigard.or.us • d� Date s ed /Mei o fi
� ��11CID t11MP� nlulelOnt Nolill%blclho d: Supplemental Information
TYPE OF WORK FEE SCHEDULE
® 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 11. for each utility conntvtiun)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
j ® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building I=1 Multi-family SFR (3) bath 399.00
Each additional bath kitchen 45.00
❑ Master builder ❑ Other: I
Fire sprinkler (_____ se . ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 1326 SW Tnr4astd SI t• ' 1 O >f\- ( Catch basin or area drain 16.60
CitylState /ZIP: Tigard, OR 97224 Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: Project name: Dakota Glen 14 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross streetidirections 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 Lot no.: 14 Water service (no. linear ft.: ) Page 2
Fixture or item
I Tax map/parcel no.: 655 C 2
Absorption valve I 16.60 ,
• DESCRIPTION OF WORK Backiow preventer ` Page 2 ,)-7. ,SS
Landscape Backflow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER 0 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
CityiStateJZIP: Lake Oswego, OR 97034 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
® APPLICANT ® CONTACT PERSON
Ice maker 16.60
Business name: Landscape Oregon, Inc.
Interceptor/grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: $ ) 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 Fax: : (503) 692 -0768 Sinklbasin %lavatory I6.60
Tub/showerishower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Landscape Oregon, Inc. Water healer 16.60
Address: 12200 SW Myslony Street Other:
Subtotal
City/State/ZIP: Tualatin, OR 97062
Minimum permit lee: 572.50
Phone: (503 -) 692 -5945 Fax: (5113) 692 -07611 Residential hackflow minimum permit fee: i:36.25 .dLn .- as
CCB Lie.: 7804 Plumbing Lic. no.: Plan review (25 %ofpermit fee)
State surcharge arge (g.% of permit fix:) _ . 96
Authorized signature: �.L.�' CL. ..I� -t��'Z �J 3 j, t/5
TOTAL PERMIT FEE
Print name: Ellen Sparrow Date: 02/15/07 I 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 MySi 'eflitis►olegy *tub3itliriii t i ®U062y Service Board.
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CITY OF TIGARD
BUILDING DIVISION V PERMIT #: PLM2007.00067
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2
Phone: (503) 639-4171 anzotothIt
Inspection Requests (24 Hrs.): (503) 639-4175 A. - 11.
INSPECTION WORKSHEET FOR DATE: 2120/2007 TIME: 7:09AM PAGE: 72
SITE ADDRESS: 11326 SW 110TH PL CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 01'l TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: BacIdlow preventer for irrigation.
OWNER: DON ivIORISSETTE HOMES, INC., PHONE #: 883-307-7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503-692-5945
Inspection Request Scheduled For: Date: 2120/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 043569-01 503-692-5945 N
Corrections/Comments/Instructions: .
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ss H PARTIAL APPROVAL n CANCEL [ I NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 1 1/ V U Date: ,.,,w w I " )Phone #: (503) 718- '?