Permit CITY TIGARD PLUMBING PERMIT
" ° `' COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00202
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 1 S134DB -11700
SITE ADDRESS: 11039 SW BRENDEN LN ZONING: R - 4.5
SUBDIVISION: DAKOTA GLEN LOT: 019 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
4230 SW GALEWOOD Description Date Amount
4230 GALEWOOD ST. #100, OR 97035 [PLUMB] Permit Fee 5/17/2007 $36.25
[TAX] 8% State Surcha 5/17/2007 $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 # : PRE 503 - 692 - 5945
FAX 503 - 692 - 0768
Reg #: L1C 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: /// jj./ L ice t ` Permittee Signature: ( � n 7
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.
. .. ,- _,,,..„.
Plumbing Permit • FOR OFFICE USE ONLY'
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City of Tigard \�� P � t� Received �� pp K y Permit No.: ( � LM rib+ ' �d
131 5 W Hal Blvd., Tigard, OR 97223 r ''' e L l Sw. llatc-liy: 51t �' v ( 5/... Permit Ll (J0025 Z
� �` ��,� Plan Review
Phone: 503.639.4171 Fax: 503.598.1 ^ 60 V er Permit No.
l �t e n h i � j ( ' Date:Rc Oth P MST - J
24- Hour Inspection Line: 503.639.4 �P��t .1 J ( mn �!
Internet: vvww.ci.ti ard.or.us No
.. Date Ready Sy: I l7 S Sec ppl Pa£e 2 for In tified. M ethod:
Su ememxl formation
TYPE OF WORK FEE* SCHEDULE
►9 New construction ❑Demolition
For special information use checklist.
Description. I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 A. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
® I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SltF INFORMATION AND LOCATION Site utilities
Job site address: 11039 SW Brenden Lane 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 19 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilitics 110.00
Cross streeUdirections to job site: SW North Dakta Street
Manholes 1 6.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Dakota Glen i Lot no.: 19 Water service (no. linear 11.: 1 Page 2
Fixture or item
Tax map /parcel no.: 655 C3
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer / Page 2 ,;7 SS
Landscape Backflow 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 1 6.60
City /State/ZiP: Lake Oswego, OR 97034 Floor drain/floor sink/huh 16.60
Phone: ( ) Fax: ( )
Garbage disposal 16.60
® APPLICANT ® CONTACT PERSON Hose bib 16.60
tee maker 16.60
Business name: Landscape Oregon, Inc.
lntenceptorigrease 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 Fax: : (503) 692 -0769 Sink basim'lavatory 16.60
Tub/shower /shower pan 1 6.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 1 6.60
Business name: Landscape Oregon, Inc. Waterlteater 16.60
Address: 12200 SW Myslony Street Other:
Subtotal
City / State/ZIP: Tualatin, OR 97062
Minimum permit ice: 572.50
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 Residential haukllow (Minimal' permit lee: 530.25 3 (' - 0)- ---S -
CCB Li c.: 7804 Plumbing Lic. no.: Plan review (25 of Permit fee)
- State surcharge OM of perrnir fee) 0 . `20
Authorized signature: , (" _.. t1 -6Z,() TOTAL PERMIT FEE ,-/ - / 5
Print name: Ellen Sparrow I Date: 05/16/07 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
• ^Tcc methodology act by I ri-County Building Industry Service Board.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00202
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/17/2007
Phone: (503) 639 -4171 /mrom�
Inspection Requests (24 Hrs.): (503) 639- 4175c'�
INSPECTION WORKSHEET FOR DATE: 6/1/2007 TIME: 7:02AM PAGE: 4
SITE ADDRESS: 11039 SW BRENDEN LN CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN • LOT #: 019 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Landscape backflow device.
OWNER: DON MORISSETTE HOMES, PHONE #: 503 -387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503 -692 -5945
Inspection Request Scheduled For: Date: 6/1/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 049432 -01 503 -692 -5945 N
Corrections /Comments /Instructions:
•l/ // //i
i
I PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / , �/ Date: / % -) Phone #: (503) 718 -