Permit : ,. CITY OF TIGARD PLUMBING PERMIT
': a ': COMMUNITY DEVELOPMENT Permit #: PLM2009 -00356
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/17/2009
Parcel: 2S102CD05200
Jurisdiction: Tigard
Site address: 13955 SW 95TH AVE
Subdivision: FLETCHER WOODS Lot: 2
Project: Fletcher Woods
Project Description: Installation of residential backflow preventer for irrigation.
Owner: FEES
STONE BRIDGE HOMES Quantity Description Date Amount
16869 SW 65TH AVE. #505
LAKE OSWEGO, OR 97035 1 ea Backfow Preventer 12/17/2009 $31.27
PHONE: 503 387 -7577 1 12% State Surcharge - 12/17/2009 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 12/17/2009 $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: , i I I I , Permittee Signa
x_•111:. A Q p
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.
ir
4
Plumbing Permit Application Msr 9 , ex,, 06
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard Received C ?
� r 13125 SW Hall Blvd., Tigard, OR 9722 C 1 of �oOQ Data/By: i / 7 09 Permit No-: i th i ke �� J•s�
Phone: 503.639.41', ] Fax: 503.598.1.6 / J Plan Review
inspection Line 503.639.4175 Date By: l Other Per, r t No
TIGARD CITY OF TIGARD Date Reaa.ry' 2-t6„. See ew e 2 for
Internet: ww�t.tigard- or.gov
TYPE OF AIDING DIVISION a
Notified/Method:
+ d' I Su 1
. - FEE* SCHEDULE meat 1 la
fo mah n
Ei Nevi construction ❑ Demolition For special information use checklist
Descri tion -
❑ Addl :ion/slterationireplacernent ❑ Other: Q E a Total
_ Nc 1- 2-family e11 eludes ± for )
it dwellings (includes 100 � . r cacti utility connection
- CATEGORY. OF CONSTRUCTJO .'" SFR (1) bath 312.70
® 1- and 2- family dwelling I ❑ Cor:unercialrndus.trial SFR (2) bath I 437.78
Q Accessory building El Multi-family SFR (3) bath 500.32
Q Master builder Each additional bath/kitchen 25 02
❑Other: __ Fire sprinkler ( sq. ft.) Page 2
:. JOB SITE INFORMATION AND LOCATIO \
Site utilities:
Job site address: I 3 95 S 95 111 /].,. 1 Catch basin or area drain 18.76
City /State;Z.1R' 1 c i te, A' clf- -� Dryx'e11,leach line, or trench chain 18.76
`� + Footing drain (no. linear 11.: ) Page 2
Suite/bldglapt. no.: Project nor y eA- ch i r '
w
! 'I Z- Manufactured home utilities 50.33
Cross streeldirections to job site: Manholes 18.76 I
s' tf /1 o- Cr Y1 �� �,�
W rn c- D (' + I C " -`-' L. Rain drain: conncctor 18.76
Sanitary sewer (no. linear fi.: ) 1 Page 2 ,
Storm sewer, no. linear ft.: ) ( Paget
�^ r � � Lot no.: W atcr service (nc. linear it: ) Page 2
Subdivision: Y� e f Cr 1)_ irJ L n
`� L` 2._ Fixture or item:
Tax map /parcel no.: S 5 Backflow preventer x 31.27 31.27
DESCRIl'7lON :OF ti ORK Backwater valve 12._51
Landscape Irrigation Backilow Device Clothes washer 25.02
Dishwasher 25.02
• Drinking fountain I 25.02
Ejectors %sump 25.02
: 0, PROPERTY OWNER . :l • - - Q TI;IvA'VT Expansion tank I2.51
Name: StoneEridge Homes NV LLC Fixture/sewer cap 25.02
Address: 16869 SW 65" Ave #505 Floor craia'flocr sinklhub 75
Garbage disposal 25.02
City /State /ZIP: Lake Oswego, OR 97035 Hose bib . o
25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
® ':APPLICANT - ®.:CO INTACT PERSON Irterceptorigrease tap 25.02 I
Business name: Landscape Oregon, Inc. Medical Sa (value: S ) Page 2
Contact name: Ellen Sparrow Pri 12.51
Address: 12200 SW Myslony Road Roof drain (commercial;' 12 51 �
5ink/hesinJ1avztor. 25.02
City/StateIZlP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax: : (503) 692 -0768 Tub /showerishower pan 1 12.51
E -mail: cllenClandscapearegon.com Urinal 25,02
CONTRACTOR -- . Water closet 1 25,02
Water heater s 37.52
Business name: Landscape Oregon, Inc. Water piping/DUrV 56 29
Address: 12200 SW Myslony Road Other: 25.02
City/State /ZIP: Tualatin, OR 97062
Subtotal 31.27
Phone: (503) 692 - 5945 Fax: (503) 692 - 0768 Iviin: mum permit fee: $72.50 72.50
CO3 Lic.: 7804 ( / I304 O Plumbing Lic. no.: f Plan review (25% of permit fee)
Authorized signature: 7 �, � / State surcharge (12% of permit fee) 8.70
✓ ` Zi (i-� TOTAL PERMIT FEE 81.20 f
Print name: Ellen Sparrow Date '1 "1 r7 'y el his permit application expires if a permit is not obtained ssithin 180 days
`' f after it has been accepted as complete.
4 *Fee methodology set by Tri -County 3uildirg Industry Service 3oa-d. •
:An u/: dins \Per.•nits1PLMU- Pcnnitelpp.doc 10.01/090 (�� 1 I.- ' 440- T(1 : /cot ma
L d 09L0-Z69-809 m� S ueii3 o9Z:80 60 L L 900