Permit ,! CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2011 00169
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/02/2011
IIG 9 Parcel: 2S 110C B 10400
Jurisdiction: TIGARD
Site address: 15444 SW ARLINGTON TER
Project: Arlington Heights No. 3, Lot 92 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 92
Project Description: Irrigation backflow device.
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 - 387 -7577
HONE: 503 - 692 -5945
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: 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 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 By: / ,(P 55)/ Permittee Signature: 9 , v l9�D/>z / _ 7 - 7dN /
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
� � ` ,\ + Date/By: d i � + o� �� t �
City of Tigard permit NwP� �/�0 f6 9
111
• r 13125 SW Hall Blvd., Tigard, O • + Q 1\ Plan Review //
Phone: 503.639,4171 Fax: 50R''S98S1960 1 Date /By: Other Permit N wSTA , / /
TLGARD InspectionLine: 391 \� \� 1 0 DateReadyl3y: un �� Seepage2tar O
Internet ww 5 .63or .4v '. , \1, . ' `( 4- Notified/tvlethod: I'L(T Supplem _
, - � . e l • . ._ FEE'`. e !al to
. . TYPE OF WORK.. s e
• .. - : .. . FEE, . SCHEDUL
. E- n
ormaiton
❑ Dee / \ c� � For special information use checklist
® New construction
� - Description f Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' CATEGORY OF CON STRUCTIOI\ - SFR Cl) bath 312,70
® 1- and 2- family dwelling ID Commercial /industrial 5FR (2) bath 437.78
• ❑ Accessory building SFR (3) bath 500.32
$ ❑Multi - family
Each additional bath'kitchen 25.02
❑ Master builder ❑ Other: • Fire sprinkler ( , sq. ft.) Page 2
- JOB SITE INFORMATION' ND LOC4TION . Site utilities: _
f,3 �,.�j , 4' TZb T� Catch basin or area drain 18.76
Job site address: J ] c R.. Drywell, leach line, or trench drain 18.76
City/State/ZIP: T q C(/.c -L 0 � / �-a- ! Footing drain (no. linear ft.: , ) Page 2
Suite/bldg./apt. no.: -J {� Project name: s
t`CY � 1 (I � { 1---- -- 2._ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S - ul 54.- l vt-t -- cL h - V Rain drain connector 18.76
,S l.t 11R Y)+.Lr L 't-}.-Ai � ) i2 t - )-f o ,- C 0Y-) I .1Yr t° f " G Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
1 inn~ 1(t1. -•t{" ( ti- ' 1,t) iY- YV1r\rvc `U 1 ] Water service (no. linear ft.: ) Page 2
Subdivision:fty'11,t191-1 t- i-e__c3 t \..., ) Lot no. Fixture or item:
Tax map /parcel no.: ( s S /1"" r7' Backflow preventer x 31.27 31.27
-
. DESCRIPTION OF WORK . Backwater valve 12. l
Clothes washer 25.02
Landscape Irrigation Backflow Device
Dishwasher 25.02
Drinking fountain 25.02 •
Ejectors /sump 25.02
® •PROPE RTY OWNER ❑ '1'EY4NT Expansion tank 12.51
•
Name: StoneBridge Barnes _NSV LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 16869 SW 65 Ave #505
Garbage disposal 25.02
City/State /ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51 ' • • ` Z APPLICANT '. ® CONTACT PERSON.' Interceptor /grease trap 25.02
Business name: Landscape Oregon, Inc. 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 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
Water closet 25.02
- CONTRACTOR . - Water W heater 37.52 h t
Business name: Landscape Oregon, Inc. Water piping,DV/V 56.29 _
Address: 12200 SW Myslony Road Other: 25.02 J
City /State /ZIP: Tualatin, OR 97062 • Subtotal 31.27
1 e: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee: $72.50 i2.50
Pt / n
CCB Lic.: 7804 Plumbing Lic. no.: Plan review (25 % of permit fee)
State surcharge (12% of permit fee) , 8.70 1
Authorized signature/ ti( / e r ? G� _- J L
TOTAL PERMIT FEE 81.20 .
Print name: Ellen Sparrow ' Date:(p I ?_c] This permit application expires if a permit is not obtained within 189 days
after it has been accepted as complete
' methodology set by Tri- County Building industry Service Board.
I.\ BuildinOemtits \PLMU-PermitApp.coc lC/61!09 440 - 4616:(] O102iCO4WEB)
1 ' d 89LO uell3 8 9010 I. •0 unr