Permit i
CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2009 -00320
s i Date Issued: 11/04/2009
:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S109ACO5000
Jurisdiction: Tigard
Site address: 13287 SW NICOLE LN
Subdivision: Lot: 0
Project: Wilson Ridge 2
Project Description: Irrigation backflow device
Owner: FEES
STONE BRIDGE HOMES NW LLC Quantity Description Date Amount
BY VENTURE PROPERTIES INC, 4230 SW 1 ea Backflow Preventer 11/04/2009 $31.27
GALEWOOD ST #100 1 12% State Surcharge - 11/04/2009 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 11/04/2009 $41.23
Plumbing
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062
PHONE: 503 - 692 -5945
FAX: 503- 692 -0768
Type of Use: SF
Class of Work: OTR 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: 4Permittee Signature: D/v /9! 'f ' G/ e 9_ 7.704/
,, ,
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.
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Plumbing Permit Application
EIV 1
Building Fixtures NOV FOR OFFICE USE ONLY
O2 21 'ieived
P''' it Icl �
City of Tigard Dateiii �1S 7 L' / �i0:�a �0
V 13125 SW Hall Blvd., Tigard, OR 97223
- CITX OF TIG' r1A Rev w Other Permit No
Phone: 503 639.4171 Fax: 503.598.1960 .'s S /;2c09 Q
TIGARD Inspection Line: 503.639.4175 BUILDING DIV S#i9 YBY` �Juri �r See Page 2for
Internet: www.ti d -or, ov `ctified/Methad: 1 ! c' i Supplemental Informa
TYPE OE WORK, _ FEE
fri New construction ❑ Dernolition For special information rue checklist
Description 1 Qty. I Ea. Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
q1- and 2- family dwelling ❑ Commercial/indus rial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
- Each additional bath/kitchen 45.00
' ❑ Master builder ❑ Other:
Fire sprinkler ( sq. R.) Page 2
. • JOB SITE:INFORMATIONAND • LOCATION, '1. Site utilities __
Job site address: 73 L S' 7 SaL; f...:::' d C (AC, L t -ri C Catch basin. or area drain 1660
City/State/ZIP: . T"1 4) (.L1CL 0 Ci.1 2? 3 Drywell, teach line, or Trench drain 16.60
Suite.'bldgJapt. no Pmjectname: W i j S 1 . 1 - :y) iP -ac(q j Footing drain (no. linear Et.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
n�` ��++ Manholes 16.60
i > -IL (1 '�) [ V (∎.P Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (nc- linear ft.: __J I Page 2
l Let no_ Water service (no. linear ft.: ) Pace 2
Subdivision:
k.�- i,SV1� M_l (Lei �
Fixture or item
Tax maprparcel no.: ......S
(rl Absorption salve 16.50
. 7 DESCRIPTION OF WORK , -'.. Backflowprevcnter x Paget 1
Landscape Irrigation Backflow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
m fountain Drinking 1660
PROPERTY OWNER " CI:,TI::N A,NT
Ejectors /sump 16.60
Name: Stone Bridge Homes LLC Expansion tank 16.60
Address: 16869 SW 65' Ave #505 Fixture/sewer cap 16.60
CityiState'7.TP: Lake Oswego. OR 97035 Floor drain/floor sink'hub _ 16.60
Phone: ( ) Fax: ( ) Garbage disposal , 16.60
• Ho 2-'b 1660
.APPLJL4NT : : - 0 ;CONTACT PERSON
. - . Ice maker 16.60
Business name: Landscape Oregon, Inc _ Interceptor /crease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: $ ) Page 2
Address: 12200 SW Myslony Road Primer 16.60
City/State/Z2: Tualatin, OR 97062 Roof drain (commercial) 15.60
Phone: (503) 692-5945 I Fax: : (503 -) 692 -0768 Sink bas nllavatory 16.60
Tub /shower /shower pan 16.60
E -mail: e11en@landscapeoregon.eom Urinal 16.60
CONTRACTOR '- _ - . - - Water closet I 16.60
Business name: Landscape /Oregon, Inc Water heater 16.60
Address: 12200 SW 4yslony Road Other:
City /StateZIP: Tualatin, OR 97062 Subtotal '2,4, 50
Minimum permit to 72 ,151
/ Phone: (503) 692 -5945 Fax: (503 -) 692 - 31n1S. 076, 1,-, Residential baclflow minimum permit fee: 36.25
DifCCB Lic.: 7804 Plumbing Lic. no.: Plan r- -view (25 % fee) t, 'id
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE 4
Print name: Ellen Sparrow Date: ) j )D-- (j This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. / at '
*Fee methodology set by Tri- County Building industry Service Board,
t` Buildihy `.Permitslr_trf PernitApF. !21:17/06 440- 4616T(17102/COM/WES) 'if
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