Permit CITY OF TIGARD PLUMBING PERMIT
� Permit #: PLM2009 -00240
COMMUNITY DEVELOPMENT Date Issued: 09/01/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102CD05800
Jurisdiction: Tigard
Site address: 13966 SW 95TH AVE
Subdivision: FLETCHER WOODS Lot: 8
Project: Fletcher Woods
Project Description: Installation of irrigation backflow preventer.
Owner: FEES
STONE BRIDGE HOMES LLC Quantity Description Date Amount
16869 SW 65TH AVE., #505 1 ea Backflow Prevention - RES 09/01/2009 $27.55
LAKE OSWEGO, OR 97035 1 12% State Surcharge - 09/01/2009 $4.35
PHONE Plumbing
9 ea Minimum Fee Adjustment - 09/01/2009 $8.70
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: ALT Type of Const:
Occupancy Grp:
Stories:
Total $40.60
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.
4 -2
Issued By: Permittee Signature: /, / C 7 c ' ". '
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.
Aug 31 09 07:18a Ellen 503-692-0768 p.2
Plumbine Permit Application
Building Fixtures r t FOR OFFICE USE ONLY
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City of Tigard 1 1LLi'C a °� :„..A.:. - / 0' m'0- Pest `fo?4 , _ i
II . U 13125 SW Hall Blvd, Tigard. OR 97223 Plan Review pi Permit Nail y�9 -QQ/
Phone: 503.639.4171 Fax: 503.598.1960gU 3 12009 nate'By J,u;,, See
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❑
Demol ition For special inforaradon use eheck11s1
El New construction Description 1 Qty. I Ea. 1 Total
Q Addition /alteration/replacement 0 der: New 1- 2- fanstly dwellings (includes 100 fl. for each utility connection)
} .. . - ; :. , r ' SFR (1) bath 2 i
� = GATEGQ��' OY� Ct!>\'STREft�i':tl�f , E . ` ` F 249 �0
,.:. -
1- and 2- family dwelling Q CommercinWindustria SFR (2) bath
l 350.00 j
SFR () bath 399.00
❑ Accessory building
❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑ OAT: Fire sprinkler ( sq. It) Page 2
_.
-
r "1":0044.r.* <1N 0.- TON ND LOCATLQN , , , .. Site utilities
Job site address: /.39,6 n-) A i< • Catch basin or area drain 16.60
City /State/ZIP: 77 q ( /t,a_ Doe- 7 ;:?*-D-41 _Drywcll, leach line, or trench drain 16.60
Footing drain (no. linear ft.: _-„) Page 2
Sttite/bldgJapt no.: Project mutt [��" s
Manufactured home utilities :10.00
Cross street/directions to job site: Manholes 16.60
me,. ` cn1 Rain drain connector 16.60
Sanitary sewer (no. linear 8.: __) Page 2
Storm sewer (no. linear ft.: ,___) Page 2
�.q • Water service (no. linear ft.: _) Page 2
Subdivision: &11....4 - WOO Lot n " + Fixture or item
Tax map /parcel no.: , 5 Absorption valve I 16.60 •
_ a D f`.* -0 01t51F - WORk } ::: Backflow preventer ; x Pege2 1
Landscape Irrigation Backflow Device µ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60 •
Y _. . Drinking fountain � 16.60
D .
[,PRQPER'Y;..1fliiE � .....• ..
Ejectors/sump sump
Y:... rm 16.60
Name: Stone Bridge Homes LLC Expansion tank - 16.60
Addr 16869 SW 65` Ave 8505 Fixture /sewer cap 16.60 _
City /State/ZIP: Lake Oswego, OR 97035 Floor drain/floor sink/hub 16.60
Phone: ( )
Fax: ( ) Garbage disposal 16.60
,_ t C C Hose bib 16.60
Q1pLit<A.�l J x1; 4 141 , r lee maker
16.60
Business name: Landscape Oregon, Inc Interceptor /grease trap 16.60 -
Contact name: Ellen Sparrow Medical gas (value: 5 ) Page 2
Address: 12200 SW ivlyslony Road Primer 16.60
City / State/ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: (503) 692-5945 J Fax:: (503 -) 692 -0768
Tub /shower /shower pan 16.60
E -mail: ellen rr landscapeoregoacom Urinal 16.60
:;, COVTR4CTOR ' 1' Water closet I6.60
Business name: Landscape Oregon, Inc Water heater 1 16.60
Address: 12200 SW Myslony Road Other:
City / State /ZIP: Tualatin OR 97062 Subtotal
"� Minimum permit fee: 572.50 36,25
Phone: (503) 692 -5945 Fax: (503 -) 692 -5945 Q 7 ( A Residential backfow minimum permit fee: $36.25
CCB Lie.: 7804 r / / Plumbing Lic. no.: Plan review (25% of permit fee)
• State surcharge (12% of permit fee) 4.35 /
Authorized signature: ' (, f,7�� {) TOTAL PERMIT FEE 40.60 V
Print name: Ellen Sparrow Date: Q7 31 , This permit application expires if a permit is not obtained within
��++ ISO days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
r? Surldin Permite.PL)ff- PermitApp. I2/27i06 470.46:67(te/02iCOMIWEB)