Permit d1TY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00204
TtGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 1 S 134DB -09900
SITE ADDRESS: 11082 SW NORTH DAKOTA ST ZONING: R -4.5
SUBDIVISION: DAKOTA GLEN LOT: 001 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 GALEWOOD ST. STE 100 Description Date Amount
LAKE OSWEGO, 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 # : PRI 503- 692 -5945
FAX 503- 692 -0768
Reg #: LIC 7804 •
A .
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: S..et 1-}pp I j (id7On
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.
L..
Plumbing Permit Appli t�y Il9E1) FOR OFFICE USE ONLY
City of Tigard MAY 1 6 201 Uate�B a5 /l3' /(�' . 5 : Permit No.: Pu� 2tx)4 - 6)204
13125 SW Hall Blvd.. Tigard, OR 97223 Plan Reiew
Phone: 503.639.4171 Fax 503.598.1960 C , -`v ®1 ���' -� �y? Date/By: Other Permit No.:(1ST i - .)4 '
.. N! J �•
24- Flour Inspection Line: 503.639.4175 BUILDING � 1 .. I� Data Reid /B . •r' �' sop va 2 for
Internet utvw.ei.tigrerd.ur.us G D NotiFicdlvtahad: I j( SupptcmcatnlInformation
TYPE OF WORK FEE* SCHEDULE
® Ncw construction ❑ Demolition For .special information uce checklist
Dcccription I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
El Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder 0 Other: Fire sprinkler(_ sq. ft.) Page 2
' JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11082 SW North Dakota Street 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 01 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: SW North Dakta Street
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.: 01 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax mapiparcel no.: 655 C3
Absorption valve 16.60 •
DESCRIPTION OF WORK Backflow prevent= f Page 2 .;):-/ . S3
Landscape Backflow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• ® PROPERTY OWNER I ID TENANT
Drinking fountain 16.60
Ejectorsisump 16.60
• Name: Don Morissette Homes Expansion tank 16.60
Address: 4230 SW Galewood Fixture/sewer cap 16.60
City /Stale/ZIP: Lake Oswego, OR 97034 Floor drain/floor sink/hub 16.60
F ax: ( ) Garbage disposal 16.60
Phone: ( ) Hose bib 16.60
® APPLICANT ® CONTACT PERSON
Ice maker 16.60
Business mine: 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 Fax: : (503) 692 -0768 5ink/bticinlavatory 16.60
! Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
i CONTRACTOR Water closet • 16.60
Business name: Landscape Oregon , Inc. . Water heater 16.60
. Address: 12200 SW Myslony Street . Other:
Subtotal
City /State/ZIP: Tualatin, OR 97062 •
Minimum permit fcc: 572.50 / -
Phone: (503 -) 692 -5945 Fax: (503) 692 -0768 I
Residential backflow minimum permit fee: S36.25 [!'
CCB Lie.: 7804 Plumbing Lie. no.: Plan review (25%ofpermit fee)
• State surcharge (8% of permit fee) �. c �U
Authorized Signature; ._Q_,, .....4-Le .....4-Le > ..AR-0 TOTAL PERMIT FEE 3 `J, i c
Print name: Ellen Sparrow I Date: 05/16107 TM; permit application expires if a permit Is not obtained within
180 days afirr it leas heeu accepted as complete.
*Ice methodology set byTrl- County Building Industry Service Beard.
is,Building\Perrri ts1PL11.Pern aAtgadoe C6/05 44 -46I 6T1'10,'02/COW14FB)
' Z'd 99L0 Z69 -009 Ue113 dCO: O LO 91. I2W
CITY OF TIGARD
BUILDING DIVISION #: PLM2007 -00204
13125 SW Hall Blvd., Tigard, OR 97223 ' DATE ISSUED: 5117122007
Phone: (503) 639 -4171 u ygyi '
Inspection Requests (24 Hrs.): (503) 639 -4175 `' __..
INSPECTION WORKSHEET FOR DATE: 6/25/2007 TIME: 7:01AM PAGE: 52
SITE ADDRESS: 11082 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: DAKOTA GLEN LOT #: 001 TYPE OF USE:
PROJECT NAME: DAKOTA GLEN
DESCRIPTION: Landscape bacldlow device.
OWNER: DON MORISSETTE HOMES, PHONE #: 503. 387 -7538
CONTRACTOR: LANDSCAPE OREGON, INC. PHONE #: 503
Inspection Request Scheduled For: Date: 6/25/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 050823-01 503 -692 -5945 N
Corrections /Comments /Instructions:
4......4 /:
4.0 , I%
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1/ 6tVL Date: Z S / Phone #: (503) 718 -2-Y1