Permit 14 CITY OF TIGARD PLUMBING PERMIT
— :: COMMUNITY DEVELOPMENT Permit #: PLM2011 -00168
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
Parcel: 2S109DA14000
Jurisdiction: TIGARD
Site address: 12677 SW MOUNT VISTA CT
Project: ARLINGTON HEIGHTS NO. 3, LOT 59 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 59
Project Description: Installation of residential backflow preventer for irrigation system.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 16869 SW 65TH AVE #505
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 692 - 5945
PHONE: 503 - 387 -7577
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/02/2011 $31.27
Specifics: 1 12% State Surcharge - 06/02/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 06/02/2011 $41.23
Plumbing
Class of Work: OTR
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued y: k J �a�� D Permittee Signature: l j J
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.
Plumbin;: Permit Application
Building Fixtures L1� r FOR OFFICE USE ONLY
JUN ecetve
City of Tigard J 1 �O„ R 1 �( , / Permit q6 / /��, 1 �
II
u 13125 SW Hall Blvd., Tigard, OR 97223 V' V DatelEy: d � L p(
Plan Review
Phone: 503.639.4171 Fax: 503.598. 196. Other Permit No.:
Inspection Line: 503.539.4175 i ® TIG pp a Date Read laps �] Seepag 2 far
TIGARD t ri`�® y>By: .
In ternet: www.tigard- or.gov BUILDIiN(- nil /lc^,�l'l A Notified/Method: Supplementallnformatioe
_ .
:: •TYPE= OF_TORK
; . •FE* SL
® New construction ❑ Demolition For specie! information use checklist.
... - -- - ..._.. -- - - - -- - . - - - - Description - -------------><--- Qty.- ---- Ea-- j---- T-otal- - - - - --
❑ Addition /alteration/replacement ❑ Other. New i- 2-family dwellings (includes 100 ft. for each utility connection)
" " "' SFR (1) bath 312.70
CATEIGORY: OF. CONSTjEi ... .
® I- and 2- family dwelling El Commercial/industrial SFR (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 SfTE INFO AND LOCATION. ,.' : - - Site utilities:
Job site address: ! , ( - Catch basin or area drain 18.76
G d-- ; !
Drywell, leach line, or trench dra 18.76
City /State /ZIP:
7~I c Gt�GL L - / 7 `
1 Footing drain (no. linear ft.: ) Page 2
Suite/bldg.iapt. no.: I Project name: -T i I nC! •izr .7 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 1 8.76
S S ux- mC_1r - Ll ,.P-C-L) D (.j Rain drain connector . 18.76
R--4 c' Sanitary sewer (no. linear ft.: 1 I Page 2
S `� ` 1 f G 1 Storm sewer (no. linear ft.: ) Page 2
5 u.' fn Gli_e ( -- \, -FCiL. .c.0 - u\-T --- '
Water service (net Iinear ft.: ) Page 2
Subdivision: (- t ' ! rl f' rn d-Ci /'l. I Lot no.: S• Fixture or itemt
Tax rnapiparcel no.: cc A- Bacicflow preventer x 31.27 31.27
DESCRIPTION. OF:;WOJEtK ° - -: .. . € ,; ,, :-:i• .• .,••- , ,:..
Clothes washer i 25.02
Landscape Irrigation Backflow Device Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
. :
tank ®_PROPERT]';01�73ER • := =; �' -- ; ": ❑ - - Expansion 12.51
, ,,,,... 'I?EN, 4,1V'I' - ton
Name: StoneB ridge Homes NW LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16869 SW 65 Ave 4505 Garbage disposal 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
' - ® 4PPLTCA NT •. :: ; - ° ® CONTACT_ PERSDN - Interceptor/grease trap 25,02
Business name: Landscape Oregon, Inc Medical gas (value: $ _ ) 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 97062 • Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax: : (503) 692 -0768 Tub!shower /shower pan 12.51
E -mail: ellen(landscapeoregon.com Urinal 25.02
. _,; : .. - .. CONTRACTOR;;.. = .- .
Water closet
.. ... .• ..: , . Rater heater 37.52
Business name: Landscape Oregon, Inc. Rater pipind'DWV 56.29
Address: 12200 SW Myslony Road Other: 25.02
City/State /ZIP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum p ermit fee: $7150 72.50
Plan review (25% of permit fee) i
CCB Lie.: 7804 Plumbing Lic. no.: State surcharge (12% of permit fee) : 8.70
(
Authorized signature; �C C.:.A../1_,/1,6 L; )
63// TOTAL PERMIT FEE S 120 •
Print name: Ellen Sparrow Date: J 20 t i This permit application expires if a permit is not obtained within 180 days
! after it has been accepted as complete.
' methodology'se: by Sri - County Building Industry Service Board.
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