HomeMy WebLinkAboutPermit CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit #: PLM2010 -00014
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/12/2010
Parcel: 2S109AC06100
Jurisdiction: Tigard
Site address: 13292 SW NICOLE LN
Subdivision: Lot: 0
Project: Wilson Ridge II
Project Description:
Owner: FEES
STONE BRIDGE HOMES NW LLC Quantity Description Date Amount
16869 SW 65TH AVE., #505
LAKE OSWEGO, OR 97035 1 ea Backflow Preventer 01/12/2010 $31.27
PHONE: 503 - 387 7577 1 12% State Surcharge - 01/12/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 01/12/2010 $41.23
Contractor: Plumbing
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD
BEAVERTON, OR 97005
PHONE: 503- 692 -5945
FAX: 503 - 692 -0768
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct question. to 0 NC by calling 503.246.6699 or 1.800.332.2344.
Issued By: lo Permittee Signature: ak
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.
I
J ` t►
Plumbing Permit ApplicationRECEIVED
Building Fixtures F O R OFFIC • USE .ONLY
JAN 12 2010 '
City of Tigard Received
DI�e -By: 1 ��
n 13 i25 Stitt' Fall Blvd., Tigard OR y77r3j OF TIGARD Ean Rev_cw I
='.. Phone: 503.639.4171 Fax. ?03.59g�O I O:.eer ?e:-nitNo. :rnsl�q�2• .
BU ILDING DIVISION D at`By:
TIGARD rtspC�tion line' 503.639.4115 Date Ready.3 eagenr
Internet: www.tigard or.gov No :.tied/Metbod: int� St:pp em 1 f rmation
:. : .:.T OF SVORK FEE* SCHEDULE;
.. . . • ; .. - - - - -- --
ll New construction • ❑ Demolit :or, For special information use checklist. __
Description I Qty. I Ea. I Iota!
❑ Addition/alteration/replacement ❑ Other: New 1- family dwellings (includes 100 ft. for each utility connection)
-: , CATEGORY OF .CONSTRUCTION SFR. (1)bath - 312.70
,
® 1- and 2- family dwc11 :ng I ['Commercial/industrial S. R (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building I ❑ Multi- family
Each additional batilc.tchen 25.02
❑ Master builder ❑ O _ (( Pa e 2
__ Ere sprinkler ( sq. ) g
JOB SITE 1T ATION AND LOCATION .: Site utilities:
Job site address: 13 2_6? 2 Su) NI col_ Leven � Catch basin or area drain 18.76
TI 5 V t C 1. q--2 2 _ 2 . Foot il, i 11112. or trench drain I Page 2 II
CitCity/State/21P:
_ - : Footing drain .:to. linear 0: 1 Page 2
Suite/bidgJapt. ro.: I Project name:() //SQ17 I (.4..y ; Manufactured home utilities 50.03
Cross streetldirections to jab site: Manholes 18.76
..c.-/ . 1 �1 � f m.7--Ai ( ys !� a s-co Rain: drain connector 18.76
t 3 3 / /� !✓
- I � S w rt I y{ � c 1 I S anitary sewer (no. linear ft.: ) Page 2
t! . I Storm sewer (rro. linear ft.: _; Page 2
1
I Water service (no. I :near ft.: Page 2
Subcivision: CA)/ (
/ / S1 �.La 9C Lot no.: 2_61 I I Fixture ur item:
Tax map/parcel no.: 3acktlonv preventer x 31.27 31.27
. DESCRIPTION OF WORK i3acicvatcrva!ve 12.51
Clothes washer 25.D2
Landscape Irrigation Backflow Device
Dishwasher 25.02 •
Drinking fountain I 25.02
Ejectors /sump I 25.02
. .. .. I - Expansion tank 12.51 • ICJ PROPERTY OWNER,' I ❑ :TENANT -
Name: StoneBridge $omen MI; LLC Fixture /seuc; cap 25.02
tn
Fluor drain/floor sinklhub 25.02
Address: 16869 SW 65 Ave 5505
Garbage disposal 25.02 _
City;Sta:e1Z1P: Lake Oswego, OR 97035 Hose bib I 25.02
Phone: ( ) Fax: ( ) Ice maker !2.51
' •• ® • APPLICANT :. . ®. CONTACT PERSON Interceptor /grease trap I 25.02 I ."
Business name: Landscape Oregon, Inc. - Medical gas (value: I ) Page 2
Primer I 12.51
Contact name: Ellen Sparrow
Roof drain (commercial) I 12.51
Address: 12200 SW R•lvslony Road _ Sirlv'basim'levatory 25.02 1
City!Statc /ZIP: Tualatin, OR 97062 I Solar units (potable water) 62.54 I
Phone: (503) 692 -5945 I Fax: : (503) 692 -0768 I Tttbishow•ershower pen 12.51
E -mail: ellen®landscapeoregon.com landscapeoregon.com
Urinal 25.02
Water closet 25.02
CONTRACTOR .... .
.. Water heater 37.52
= Business name: Landscape Oregon, Inc. Rater piping/D1V v 56.29
Address: 12200 SW Myslony Road Other.. 1 25.02
City/State2IP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 - 5945 Fax: (503) 692 -0768 Minimum pe rit foe: 572.50 72.50
Plan review (25% of permit fee)
CCB Lic.: 7804 Phunb'.ng Lic. no.:
State surcharge (12% of permit fee) 8.70 --
Authorized signan (Ciln r[: L.0 �'\ TOTAL PERMIT FEE 81.20
Date "' f 1 ._ . - j I ( � This perrr.it application expires if a permit ls out obtained within ISO days
Print name: Ellen Sparrow after it has been accepted nu complete.
^Fee methodology set by Tri -Cccnty Building Industry Service Board.
t:'.13,1 i1CingTermitAK .Mt.t- ?ermitApp.doc :0.C•1h09 440 -Id Id :tolob'CO\yWEB)
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