Permit c
CITY OF TIGARD PLUMBING PERMIT
: lit - COMMUNITY DEVELOPMENT Permit #: PLM2009 -00241
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/01/2009
Parcel: 2S102CD05500
Jurisdiction: Tigard
Site address: 13864 SW 95TH AVE
Subdivision: FLETCHER WOODS Lot: 5
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
LAKE OSWEGO, OR 97035 1 ea Backflow Prevention - RES 09/01/2009 $27.55
PHONE: 1 12% State Surcharge - 09/01/2009 $4.35
Plumbing
9 ea Minimum Fee Adjustment - 09/01/2009 $8.70
Contractor: Plumbing
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.
Issued By: Permittee Signature:
" Cr
i
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.
dig 31 09 06:14a Ellen 503 p.2
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
City of Tigard
0 13125 SW Hall Blvd., Tigard, OR 97223 ?lea Review
AU 3 1 2009
M 1
Phone: 503.639.417l Fax; 503.598 OF TIGARD I g c te 6 ',13,:: 09 ,' P N 5' -
Date/By: Other ParinitNeys00 .7--doi
T [GARD .0
Inspection Line: 503.639.4175 Data Ready/i3y: Mb; , S Page 2 for
BUI DIVISI
Inkmet: www.tivird-ougov LDING ON Nali.5actiMethod: - /.1/ . Supplemental information
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FM' spedal informal:on use chee.klist.
!SI New construction ID Demolition
Description I Qty. I Ea I Total
0 Addition/alteration/replacement 0 Other: New 1- 2-family dWellings (includes 100 ft. for each utility connection)
-•=tt:' akiikoblii: :0:666,10 fi!...; :,t -i: SFR (1) bath 24920
[1 1- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00
SFR (3) bath 399.00
0 Accessory building 0 Multi-family
Each additional bath/kitchen 45.00 1
0 Master builder 0 Other: Fire sprinIder ( sq. ft.) Page 2
6111)11F0132■10r9rf Iii4P-Loc.01q - - , ,.: . -•,;: Site utilities
Job site address: 3 8" g w q5ti ituc, Catch basin or area drain 16.60
City/State/ZIP: Ti c i evict_ C 9 - 2 d-a-q DinVell, leach line, or trench drain 16.60
Suite/bIdgJapt. no.: 1 Project name: Ft c_i: a wocr_Ls Footing drain (no. linear ft.: 1 1 Page 2
Manufactured home utilities 110.00 ;
Cross street/directions to job site: Manholes 16.60
S rCit..) rrIc_.01-1a_re..c.t. .....ctrr_521 -, Rain drain connector 16.60
s w q f. /4-0 _. Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ____) Page 2
Subdivision: A C,4 er 1,0 00 Ct...S I Lot no.: C,.) Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.: 6:, ST' ' ;• valve 16.60
* =!' . ':':r - 4 - :: ' !.,::: -. ...1= E'.:. :1ESOlirtjOS. 614 *-b 1 iik 5: ' :',-, -' -...: ': `- 7 ' Backflow preventer x Page 2 1
Landscape Irrigation Bacidlow Device Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• .., .- Drinking fountain 16.60
:- - •-• ,- tO. a iiii**iit...Oirmti6: .. ! 71. -:...-:.•-*-,-, .7 ::10,10 ::,--.=.-..,:_- -,.,, . .
16.60
Name: Stone Bridge Homes LLC Expansion tank 16.60
Address: 16869 SW 65 Ave #505 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
- - , Hose bib 16.60
.:'-'• - ,
• - 0 APPE1Qiki' t ',' '-- : - . :'' ' tj,C01`4Att:P'
Kemaker 16.60
• Business name: Landscape Oregon, Inc
Interceptor/grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: $ ) Page 2
Address: 12200 SW Myslony Road Primer 16.60 j
City/State/ZIP: Tualatin, OR 97062 Roof drain (commercial) 16.60 1
I
Phone: (503) 692-5945 Fax: : (503-) 692-0768 Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60 i
E-mail: ellen@landscapeoregoa.com Urinal - 16.60
;•-:;1 -..f.f.. .-_ -"..',, , . :, .-....,„ -, ,: 7 .' '1'..:',:.; : -,.... QPNT.14q9 : ' -- :: Water closet 16.60
Business name: Landscap5/Oregon, Inc Water heater 16.60
Address: 12200 SW Myslony Road Other:
Subtotal
CitylStaterLIP: Tualatin, OR 97062 Minimum permit fee: $72.50
Phone: (503) 692-5945 Fax: (503-) 692-"V1r 0 7 Residential bacicflow minimum permit fee: $36.25
CCB Lic.: 7804 ••'' Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) 4.35
Authorized signature: _ TOTAL PERMIT FEE - 40.60
Print name: Ellen Sparrow Datei ai 1 0 9 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
LT.So if dingTecmits`PLMT-PermitApp doc 1212 7106 443-46161 ( 10 /C 2 ICOMAVIEB)
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