Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010-00217
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/06/2010
fsiGrARI} Parcel: 2S109DA18000
Jurisdiction: TIGARD
Site address: 15243 SW SUMMERVIEW DR
Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 109
Project: Arlington Heights
Project Description: Backflow preventerfor irrigation.
Owner: FEES
STONE BRIDGE HOMES NW, LLC Quantity Description Date Amount
16869 SW 65TH AVE., #505
LAKE OSWEGO, OR 97035 1 ea Backflow Preventer 07/06/2010 $31.27
PHONE: 503 387 -7577 1 12% State Surcharge - 07/06/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 07/06/2010 $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.
din
Issued By: Permittee Signature:
e
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 CV\ 14
Building Fixtures - �`L ' 7
al 131 ' ", sFOR OF CE USE ONLY .
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t : ; F CI of Tigard C� --7 ( - �
, f f ' err Permit No. :. Pi e yvvi r -�a,;I
Tigard � � � +(�� QiJat ' ' ! '' ' 1 ' nVl�
25 SW Tail Blvd., Tigzrd, OP. 97223 4
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Phone: 503.639.417.1 Fax: 503.598.1960 Other Permit No.' iM 5 , ,: l _ c)C0'�6
D atelBy: r l �t1
Inspection Line: 503.539.4175 �,��' torts, Z See Page 2 for
71G1\RD „ Internet www.t] and -or. oar �� No /Me llo: g
g g 0 \�y NotifedlMewod: - C.{.3ll Supplemental Information
-
TYPE OF R ORK " ' T ES * SCHEDL .
New construction ❑ Demolition • For special information use checklist.
Description 1 QY. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each uti]ity,coinection)
.t.i.
CATEGORY OF CONSTRLCTION SFR (1) bath 312.70
El 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory' building ❑ Multi- family
Each additicnal battiMtchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) ! Page 2
t1 k JOB SITE L\FORMATJON A7 D LOCATIOI\, • Site utilities:
•
rr s,.2
Job site address:/, Z C 7 - t L . . - ( .L 1 O i e i ^ Lrl e j)i & Catch'bas n or area drain
18:76
Drywell, leach l ne, cr trenc dram
18.76
Cityi StatelZlP:i C L . c /\ 7 f� Footing drain (no. linear ft.: � ) I Page 2
Suitt/bldg./apt. no.: I Project name: fir C
/i') / -t-zrr f (.9
h7anucturec home utilities 50.03
Cross street/directions to job site: Manholes 18.76
' Rain Crain connector J 38.76
P..° U C��c � - ek:C� ' �i'�,% SL�.t7Z lYl,� -�" -
Sanitary sewer (no. linear ft.: _ ) ' Page 2
Storm sower (no. linear ft:: _, Page 2
Jl � + Water service (no. linear ft.: -� Page 2
Subdivision: ) 1 nC y) 1 q I'tf 1 Lot no.: 1 C Fixture or item:
Tax map /pa. col no.: (4 f f !/ j Backflow preventer x 31.2'7 31.27
1 DCRIPTiO Vs,ORK Saccwatervalve 12.51
" LS Clothes washer 25.02
Landscape Irrigation Backflow Device Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PItOPERT'Y OWST? _ ❑i TEN 4NT Expansion tank 12.51
Name: StoneBridge Homes NW LLC Fiaturels_wer cap 25.02
Floor drain/lloor sink/hub 25.02
Address: 16869 SW 65t Ave 8505
Garbage disposal 25.02
CityJStateJZTP >Lake Oswego, OR 97035 Hose bib 25.02 '
Phone:,( ) Fax: ( ) Ice maker 12.51
;I1 d,PPLICA , : ,, .: ::::?:r::::,,,..::,.0; ::r i r' : i? lfgg CO'v"TAGI PERSON Interceptor(grease trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: $ ) E Page 2
Primer j i 12.51
Contact came:: Ellen Sparrow
Roof drain (commercial) • 12.51
Address: 12200 SW MysIony Road Sirtk basin/lat atory 25.02
City /State/ZIP: Tualatin, OR 97062 Selar'units (potable water) 62.54
. Thome: (503) 692 -5945 Fax: : (503) 692 -0768 Tub /shower /shower pan I . 12.51
Email: ellen @Iandscapeoregon.com _Urinal 2 5 02
Water closet 2 5 -
i CONTRACTOR Water heater 37.52
Business name: Landscape Oregon, Inc. Waterpiping/DWV 56.29
A4 ` ss: 12200 SW MysIony Road Other: 25,02
Ci` IStt:telZ>P: Tualatin, OR 97062
Subtotal 31.27
1 1 Minimum permit fee: S72.50 72.50
Phone: (503) 692-5945 I Fax: (503) 692 -0768
� CCB ,Lie.: 7804 I Plumbing Lic. no.:
Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
1 Authorized signatufre f7 6ivt4.. JL J TOTAL PERMIT FEE 81.20
1 i
' �f � ('
s permit an expires if a permit is not obtained within 150 dnya
Printna re; Ellen Sparrow Date:
alter it bas been accepted as complete.
M ` `Fee methodology se: by Tn -Count' Building Industry Service Board.
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