Permit 14 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00149
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 2S109DA13900
Jurisdiction: Tigard
Site address: 12685 SW MOUNT VISTA CT
Project: Arlington Heights No. 3 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 58
Project Description: Repair of 5' of sanitary sewer line.
Contractor: LEGACY PLUMBING Owner: STONE BRIDGE HOMES NW LLC
8985 SW HAZELVERN WAY 16869 SW 65TH AVE, STE 505
PORTLAND, OR 97223 LAKE OSWEGO, OR 97035
PHONE: 503 - 816 -8887 PHONE:
FAX: 503 - 297 -4587
FEES
Quantity Description Date Amount
5 If Sewer Service 05/11/2011 $62.54
Specifics: 1 12% State Surcharge - 05/11/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 05/11/2011 $9.96
Plumbing
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 'cation ter. Tho - rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or di ct questions to OUNC s ailing 5t • 232.1987 or 1.800.332.2344.
4)124 &_ _V:) - T e.,L_c___
Iss ed By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 Application
Building Fixtures • FOR OFFICE USE ONLY
City of Tigard Received mom bat-7 ,,.on
Deceive - Permit No.: b
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan v Review
Phone: 503.639.4171 Fax: 503.598.1960 /�i� .ley: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD i+ �' ` ' *. y: Juris: 0 121 See Page 2 for
Internet: www.ti m"d -or. ov
�' $ A � N.'"7t7, v / B lethod: Supplemental Information
TYPE OF WORK 'VlAY 1 1 7r v,, FEE* SCHEDULE
0 New construction ❑ Demol' ioc Ty t tf / / For special information use checklist.
FT D Description Qty. 1 Ea. I Total
❑ Addition /alteration /replacement ❑ Other: U �LD 1111 G � ARD New I- 2- family dwellings (includes 100 0. for each utility connection)
CATEGORY OF CONSTRUCTION ''� ® f �l SFR (1) bath 312.70
® I- and 2- family dwelling ❑ Commercial /industrial SPR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 12(p SW NI 0 Ut•rT VI5 ?J, couL -r Catch basin or area drain 18.76
Drvwcll, leach line, or trench drain 18.76
City /State /ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: _ ) Page 2
Suite /bldg. /apt. no.: J Project name: Arlington Heights Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ti.: S ) ) I'agc 2
Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Arlington Heights J Lot no.: Cj� Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New, Single Family Residential Dishwasher X5.02
Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Stone Bridge Homes Fixture /sewer cap 25.02
Floor drain /floor sink /hub 25.02
Address: 16869 SW 65 Avenue #505
Garbage disposal 25.02
City /State /ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: (503)387 -7577 Fax: (503)387 -7615 Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: SEE ABOVE Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Deirdre Britt
Roof drain (commercial) 12.51
Address: Sink /basin /lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
-
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: dbritt @stonebridgehomesnw.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Legacy Plumbing Water Pm'
i P b /DWV 556./9 9
Address: 8985 Hazelvern Way Other: 2 5.02
City /State /ZIP: Portland, OR 97223 Subtotal
Phone: (503) 816 -8887 Fax: (503) 297 -4587 Minimum permit fee: $72.50 '7,2 • Sa
Plan review (25% of permit fee)
CCB Lie.: 159281 Plumbing Lic. no.: 26 -517PB
�� ��� State surcharge (12% of permit fee) S .
Authorized signature: �`, TOTAL PERMIT FEE
Print name: Matt Nelson Date: 05. I I , l I This permit application espires 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.
I:Anui !cling V Permits Vl'I_M1J- PcnniiApp.doc 10/01/09 440 -461 i(II /'02 /COM /P'I /It)