Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00198
T1CARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/23/2011
Parcel: 2S110CB09900
Jurisdiction: TIGARD
Site address: 15368 SW ARLINGTON TER
Project: Arlington Heights No. 3, lot 87 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 87
Project Description: Backflow for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 16869 SW 65TH AVENUE #505
TUALATIN, OR 97062 TIGARD, OR
PHONE: 503 - 692 -5945
PHONE: 503 - 387 -7577
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/23/2011 $31.27
Specifics: 1 12% State Surcharge - 06/23/2011 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 06/23/2011 $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: .. , 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 4c p
Building Fixtures •C .c FOR OFFICE USE ONLY
City of Ti 0 \ Received / Permit No..
pt
w 0 -C�
Tigard � Pla Re : fA � ' /l ) • . 13125 SW Hall Blvd., Tigard, OR 97223 � `1 ply Review
Phone: 503.639.4171 Fax: 503.598. i � G od Otter Permit No.: M ma B y : v (l 1 (o
T IGARD Inspection Line: 503.639.4175 lS1 Date / Date ReadyBy: /uric: H See Page 2 for
Internet: www.tigard-or.gov * Notified /Method: > p Supplemental Information
_ .. . . .: . _ :..::....:
. .. .. . TYPIe old wo � � sca0nvl, ;:':,.: _ .: ! :...±-....:::.. -:
® New construction f Vemolition For special information use checklist.
Description I Qty. Ea. I Total
❑ Addition `alterationlreplacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CAiEGORY__OF_ CO 1' $ TRUCTION; . _ SFR (1) bath 312 70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath j 437.78
Accesso. buildin SFR (3) bath 500.32
ry g � Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
-. J J SITE - -1 \ '_ F ORMATION :AND, LOCATION? = Site utilities: •
Job site address: f S.3 & Q 31€,: 11--(11 riC '}t ry ', Catch basin or area drain ] 8.76
Drywell, leach line, or trench drain 18.76
City/State /ZIP: 71 GtDthy� 0 C Cr ),1.- a
J Footing drain (no. linear $.: ) Page 2
Suite /bldg. /apt- no.: Project name: j 1 1'1 c) tyro 6i 7 Manufactured home utilities 50.93
Cross streetidirections to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear fr.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft. ) I Page 2
Subdivision: i+)"1 i »-C, t J n /- Gi f'1L� I Lot no.:e'7 Fixture or item:
Tax man/parcel no.: JJ Backflow preventer x 31.27 31.27
-
•� Backwater valve 12.51
` .,: UIESCRIP:TION ` - OF ... .. l
- - Clothes washer 25. 02
Landscape Irrigation Bacltflow Device
Dishwasher I 25.02
Drinking fountain I 25.02
Ejectors/sump 25.02
0, :OWNER :: " .. : :' .':;" : :' 0 TE. .... . .
Name: StoaeBridge Homes NW 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
. ®;APPLICANT=;_ °:: :. ._:.._. er forlgrease. rap 25.02
._ ; ®: COIYTi£T: PERSON .'`_ cep
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) 62.5L
Phone: (503) 692 -5945 I Fax: : (503) 692 -0768 Tub /shower /shower pan 12.5]
E -mail: e11en)1andscapeoregon.com Urinal 25.02
...._
Water closet 25.02
_`... `'` '•' Water
- - • - heater 3'7.52
Business name: Landscape Oregon, Inc. Water piping/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 permit fee: $72.50 72.50
CCB Lie.: 7804 Plumbing Lie, no.: Plan review (25% 0 of permit fee)
r - 1 State surcharge (12% of permit fee) 8.70
Authorized signature � j .2 GLZ j_,2,1C.}- TOTAL PERMIT FEE 81.20 1
Print name: Ellen Sparrow Date: I � r, f This permit applirati en expires if a permit a not obtained within 1S0 days
/ 9 y O after it has been accepted as complete.
6[t 'Fee methodology set by Tri -County Building industry Service Board,
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