Permit
CITY OF TIGARD PLUMBING PERMIT
r COMMUNITY DEVELOPMENT Permit: PLM2009-00319
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2009
Parcel: 2S102CD05100
Jurisdiction: Tigard
Site address: 13979 SW 95TH AVE
Subdivision: FLETCHER WOODS Lot: 1
Project: Fletcher Woods
Project Description: Irrigation backflow device.
Owner: FEES
STONE BRIDGE HOMES Quantity Description Date Amount
16869 SW 65TH AVE #505
LAKE OSWEGO, OR 97035 1 ea Backflow Preventer 11/04/2009 $3127
PHONE: 1 12% State Surcharge - 11/04/2009 $8.70
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 $81.201
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:G%~}7~q / - Permittee Signature: ax-j
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.
. ..1■
. .
ft
Plumbing Permit Application RECEIVED
Building Fixtures NOV 0 2-2p0 FOR OFFICE USE ONLY
City of Tigard .3 Received i . .47,
pte e
i 9 Of •r Permit Nvozmapei-0.319
q 13125 SW Hall Bh:d., Tigard, OR 97223 Review
• Phone: 503.639.4171 Fax: 503.59L1.950 OF TIGARu'n Other Pcrmit Nn
Inspection Line: 503.639.4175 VLANNINTENGINEENci
TIGARD SOY: t See Page 2 for
Internet: wv.rw.tigard-or.gov i•r d/
on6eNiediod: . Jill . 'ID ,I,
I Supplemental Information
: • ...', :T. :. -=''':' • :?: --- ' 1 • f'' 7 . 1 :. ...TYPE- bf WORK ::: : •-- q. - '' •'.. ' ' • -:'-:..: V.: • . ;•• - ::: - :4 : ":.!:-.. ' ', .. itti..seittrartg -
El New construction 0 Demolition For special informafian use checklist
Description I Qt'. I Ea. I Total
0 Addition/dictation/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
.ii' .::..... :4Ticcigi• OF CONSTRUCTION 1••: : ',.. 1:. ,. 1• - :::::: - • SFR (I) bath 249.20
and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
0 Accessory building ' 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
D Master builder i 0 Other:
Fire sprinkler ( sq. ft.) Page 2
:: • '; i': - .i'f ..- ' ' . JOB SITE :INFORMATION AND LOCATION': : -=', - ':,. r , • . • - •
Site utilities
Job site address: / I '7 q “o q 5 - rp-i A Catch basin or area dr 16.60
CityiState/ZT: TT q out c L. »c .2, ..3 Drywell, leach line, or trench drain 16.60
Suitefbldg./apt.no.: ) Project flamer( e-i-cher (A.) cc-ct. 0 1 Footing drain (no. linear EL: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
SA,L) rY b LY" c..t. ..C Rain drain connector .. 16.60
Sanitary sewer (no. linear ft.: __) Page 2
Storm sewer (no. linear ft.: __.) Page 2
Subdivision: -Pi C4-C4n Co's Lc 0 OCk. Lot no.. 0 I
1 • - Water service (no. linear 2.:. ) Page 2 •
Fixture or item
Tax map/parcel no.: G S L co
Absorption valve 16.60 •
- • :.: : '2-. : . • ".. ...;•2
DESCRIPTION O WORK ',.. - -'... . -: _: . ..',: ; :::. •
. . . . ... : • ,. :: .,. ._ _ . , . . . -.z .; .: . ; ... • , , , ::. - :: . R ackflow preventer x Page 2 1
Landscape Irrigation Backflow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
, , . ,.- . Drinking fountain 16.60
' 4 - ..- • = ' bi OWNER :A ' ' : ,:- • • • -' ' :L. ID .T6f.A NT,': . : : ''.'• , i' ••
Ejectors/sump 16.60
Name: Stone Bridge Homes LLC Expansion tank 16.60
Address: 16869 SW 65 Ave #505 Fixture/sewer cap 16.60
City/State/7.2: Lake Oswego, OR 97035 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
16.60
-'• .. " , • 1 '•614 :.. : ... .:X deyNiAtt kitkirr
I 6.60
Business name: Landscape Oregon, Inc '
Interceptor/grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: S _ ) Page 2
Address: 12200 SW Myslony Road Primer 16.60
Roof drain (commercial) 16.60
City/State/ZIP: Tualatin, OR 97062
Phone: (503) 692 -5945 Fax: : (503-) 692-0768 Sink/basinilavatory 16.60
Tub/shower/shouer pan 16.60
E-mail: ellen@landseapeoregon.com Urinal 16.60
- --. -•-• -.: -.::. - . - . i , - - - • z..CONTRACTOR . : :::• • .- - '" - l' . , i , i ,. ''" Water closet 16.60
Business name: Landscape/Oregon, Inc Water heater 16.60 .
. Address: 12200 SW Myslony Road Other: •
.2
•
City/Stain/ZIP: Tualatin, OR 97062
ini Sub 7 ,.co
Minimum mum permit f : s72
Phone: (503) 692-5945 Fax: (5113-) 692-311115. 074 g. Residential backflow minimum permit fee: 6.25
_ -.4..
jr Lic.: 7804 ill g 0 I 0 q Plumbing Lie. no.: Plan review (25% of permit fee) r , 70
State surcharge (12% of permit fee) ..4..35.---
Authorized signature:
TOTAL PERMIT FEE
_____
Print name: Ellen Sparrow t 11-doci This permit application expires If a permit Is not obtained within
180 days after it has been accepted as complete. r/. AO
*Fee methodology set by Tri-County Building Industry Service Board. 1..e"
eauleingTerraitAFLMF-FermitApp doe 12.27/36 e40-te 267.00/02/COMMEB)
Z .CI 29L0 uell3 B0Z:90 60 ZO AoN