Permit CITY OF TIGARD PLUMBING PERMIT
. COMMUNITY DEVELOPMENT Permit #: PLM2010 -00359
TIGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/02/2010
Parcel: 2S109DA18100
Jurisdiction: TIGARD
Site address: 15209 SW SUMMERVIEW DR
Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 110
Project: Arlington Heights No. 3, Lot 110
Project Description: Backflow for irrigation.
Owner: FEES
STONE BRIDGE HOMES Quantity Description Date Amount
16869 SW 65TH AVENUE #505
LAKE OSWEGO, OR 97035 1 ea Backflow Preventer 11/02/2010 $31.27
PHONE: 503 387 -7577 1 12% State Surcharge - 11/02/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 11/02/2010 $41.23
Contractor: Plumbing
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD
TUALATIN, OR 97062
PHONE: 503 - 692 -5945
FAX: 503 - 692 -0768
Type of Use:
Class of Work: 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: r
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 Applicatio
Building FixturesECEI FOR OFFICE USE ONLY
6� _
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City of Tigard �/ , Permit No.; ♦ to v - -
I II n 13125 SW Hall Blvd., Tigard, OR 97223 N U Y 1 2010 Plan Review
2 Phone: 503.639.4171 Fax 503.598.1960 Daten3y. Other Permit No .: /►l_)+v_Uaj
TIGARD inspection Line: 503.639.4175 CITY OF TIGARD DateReadyBy: • 1a,,: 21 See Page 2 for .
Internet: www.tigard- or. gov e
LDII�lG DIVISIOiV ;.. :, Nonfi
.:..: • .. .:::::. ::.. . TYPE OF R d�l� _
® New construction 1 ❑Demolition For special information use checklist
• Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other. ; New 1- 2- family dwellings (includes 100 ft. for each utility connection)
- : . CATEGORY OF CONSTRUCTION = SFR (1) bath 312.70
ri 1 - + and 2- family , ❑ Commercial/industrial SFR (2) bath 437.78
buildin SFR (3) bath 500.32
❑ Accesso
ry g ❑ Multi- family
Each add tional bath /kitchen 25.02
❑ Master builder I ❑ Other: Fire sprinkler ( sq. R) Page 2
` JOB - :S1TE INFURMATION'ANDLOCATIOPF` '
. _ - - Site utilities:
Job rite address: 1 ,p_OCJ 1& 76
�A-4) �t-4 -m }7l ei 10Jo
Carch b asin or area drain
City/State/DP: ` - c..i�.('_ 0 /� G) -'7 !� DrylrrEl, leach line, or trench drain 18. ib
Footing drain (no. linear ft.: Page 2
Suitelbldglapt no.: 1 Project name: rl / /1 G( t7.11 He"- q 1A:k Manufactured home utilities 50.03
Cross street/directions to job site: ✓ / Manholes 18.76
w . ' e c e , -L _L: C,f 1 1 / I `t az Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
�'i.t� ci.Ll `n rYl (� +J L fi r? .
Stour sewer (no. linear R.: ) Page 2
Water service (no. linear ft.: ) I Page 2
Subdi'vision: f (1r 7 j` z Lot no.: 7/ Q Fixture or item:
Tax map /parcel no.: j 5 - ! Backllow preventer x 31.27 31.27
. ; . , ._ atery ve
;; .:: < _ .. , ESG72 Off; wain( ' " ., :'. '
:.. ,
Clothes washer 25.02
Landscape Irrigation Backflow Device
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02 •
: �. JPROP1rRTY OAV�iElt' . ..... ' � : � [ , ,;,. :,. i , ❑.`TENAN']t : Expans
to
ion -tic 12 51
Nance: 5taneBridge Homes NW LLC Fixntre/sewer cap 25.02
A Floor drain floor sickAtub 25.02
ddress: 16869 SW 65 Ave 0!505
Garbage disposal 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib f 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
- : :.: ® A PPL[CANT; '. 1 : : :; ,: `. ®•CorrACT.FERS0,:1 :• . ` Interceptor /grease trap 25.02
Business name: Landscape Oregon, Ina Medical gas (value: S _) Page 2
Primer 12.51
Contact name: Ellen Sparrow
Roof drain (commercial) 12.51
Address: 12200 SW Myslony Road Sink/basin/lavatory 25.02
City /State /ZIP: Tualatin, OR 9 7062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 I Fax:: (503) 692 -0768 Tub /shower /shower pan 12.51
E -mail: ellenandscapeoregon.com Urnal 25.02
@l
- . -- ; Water closet 25.02
Water heater 37.62
Business male: Landscape Oregon, Ina Water piping(DWV 56.29
Address: 12200 SW Myslony Road Other: 25.02
Ci y /State /ZIP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 : (503) 692 -0768 Minimum pe mit fee: 572.50 72.50
Fax
CCl3 Lie.: 7804 umbing Lic. no.:
Plan review (25% of permit fee)
i State surcharge (12% of permit fee) ) 8.70
Authorized signature : -yL�c� _.�!72 . ( 44 �"� L' TOTAL PERMIT FEE 81.20
1 ' This permit application expires if a permit is not obtained within 180 days
Print name: Ellen Sparrow Date:, / ` / _ (p 0 �) after it hrls been accepted as wmplete
"Fee methodology set by Td -County Building Industry Service Board
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