Permit CITY OF TIGARD PLUMBING PERMIT • '!' COMMUNITY DEVELOPMENT Permit #: PLM2010 00051
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/17/2010
T I G rt R D Parcel: 2S109ACO5500
Jurisdiction: Tigard
Site address: 13199 SW NICOLE LN
Subdivision: WILSON RIDGE NO. 2 Lot: 23
Project: Wilson Ridge II
Project Description: Install backflow for irrigation.
Owner: FEES
STONE BRIDGE HOMES NW LLC Quantity Description Date Amount
BY VENTURE PROPERTIES INC, 4230 SW
GALEWOOD ST #100 1 ea Backflow Preventer 02/17/2010 $31.27
1 12% State Surcharge - 02/17/2010 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 02/17/2010 $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: SF
Class of Work: ALT 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 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.
Plumbing Permit ApplicatialRECEIVED
Building Fixtures F USE ONLY
FEB 1 7 2010
Received
City w. Tigard
d Date lly. Permit No.: 17 12C)(c • 0 00:.
q 13125 SW Had Bled., Tigard, OR 9
Inspection Line: 503 6391175 P lan Review
Phone: 503.639.4171 Fax: 503 5 �i
OF TIGARD
Other Puma NNo.:/t/ j 9 D ar
R ILDING Datel
. G DIVISI DateRcad B ° lens: 1 O SeePag
TIGARD In:cmet: wh�c 1i . a rd -or. ov y y' e 2
g S Notified/Method: Supplememtallnformstioa
TYPE OF WORK. : i FEE" SCFIEDL!LE • • • •
® New construction ❑ Demolition For special information use checklist
Description I Qty. Ea. 1 Total
❑ Addition/alteration /replacement i ❑ Other: New 1- 2- family dwellings (includes 170 ft. for each utility connection)
' CATEGORY • OF CONSTRUCTION SFR (1) bath I 312.79
® 1- and 2- family dwelling I ❑ Commercial /industrial SFR (2) bath 437.78 1
❑ Accessory building [] Multi-family SFR (3) bath 500.32
Each additional bat:a/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkle: ( , sq. ft.) Page 2
JOB SITE - INFORMATION. AND LOCATION • Site utilities:
✓Job site address:' 3i 5 y .54.4._.) ki o e ol& L.,: Z; V ! Catch basin or area drain I 18.76
Drywel!, leach line, cr trench drain I 18.76
City/State /ZIP: T if. ct i v i_ c ,n ‘11 3- 3 Footing dram (no. Iinear .: ) Page 2
Suite/bldg./apt. no.: / I Project n�3 a 1 S ( .n Q ;3 Manufactured home utilities 50:C3
Cross streetidirections to job site: 1 Manholes I8 76 I i
� G-i..LLC, l'- L4 ' /r, . >.j .0 / 3 - Rain drain connector I 18.76
I t Sanitary ;ewer (no. linear ft ; 1 ! Page 2 I
Storm. sewer (no. linear ft.: Page 2
\Vatzr service (no. linear ft.: _) Page 2
Subdivision: LC. l (cc iL C.L9 -c., I Lot no.: : 3 Fixture or item:
Tax inaplparcel no.: c ,A--i. f Rack(lowpreventer x 31.27 31.27
DESCRIPTION OF WORK Bacl7satervalve 12.51 •
Clothes washer 25.02
Landscape Irrigation Backflow Device
Dishwasher 25_02
Drinking fountain I 25.02
Ejectors/sump 25.02
® PROPERTY OW\FR Q TENANT Expansion tank 12.51
Name: StoneBridge Homes NW LLC Fixture/sewer cap_ _ I 25.02
Floor draia%floor sinkrhub 25.02
Address: 16869 SW 65' Ave €1505
Garbage d;spesal • 25.02
CityfState,'ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) Fax: ( ) I ice maker 12.51 i
® A,PPLICANT ® CONTACT PERSON _ Intcrceptorigrease trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: l Page l
Prune: I 12.51-
Contact name: Ellen Sparrow
Roof drain (commercial) 12.51
Address: 12200 SW :Mfyslony Road Sirik'bnsin/lavatory r 25.02
City /State /ZU Tualatin. OR 97062 Solar units (potable water) 1 62.54
Phone: (503) 692 -5945 Fax: : (503) 692 -0768 Tub /shower /shower pan 12.51
E -mail: ellengIandscapeoregon,com Urinal 25.02
Water closet I 25.02 I
' CONTRACTOR . - • -
Water heater 3752
Business Warne: Landscape Oregon, Inc. Water piping/D1l V 56.29
Address: 12200 SW Ylyslony Road Other: I 25.02 1 1
City /StatefZTP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum pewit fee: 872.50 72.50
Plan review (2514 of permit fee)
CCB Lic.: 7804 Plumbing Liz. no.:
�J _ State surcharge (12% of permit fee) 8.70
Authorized signatu e: , Q./'C(. /lit t; TOTAL PERMIT FEE 81.20
Print name: Ellen Sparrow , ,'7�) J cati
This permit applion expires if a permit is not obtained within 180 days
±1424/ after it bas been accepted as complete,
i.
'Fee methodology set by Tri- Coun:y y' Building Iniust Servict Board.
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