Permit � CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00227
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011
Parcel: 2S109DA14800
Jurisdiction: TIGARD
Site address: 15294 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 67 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 67
Project Description: Irrigation backflow device.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
12200 SW MYSLONY RD 16869 SW 65TH AVE #505
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
P
PHONE: 503 - 387 -7577
PHONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/15/2011 $31.27
Specifics: 1 12% State Surcharge - 07/15/2011 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 07/15/2011 $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 By: Permittee Signature: /• ,Q_ "
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 A lication ����
Building Fixtures V FOR OFFICE USE ONLY
Cit3 of Tigard 1 4 2011 Received 7/' /// , Perna No // t'O 2z 7
Irr
m 13125 SW Ha'.l Blvd., Tigard, OR Plar. Review
Phone: 503.639.427'. Fax: 503.598.1960 Other Permit NY'1 / /.-deOg
Date(3y:
Inspection Line: 503.639.417' l ry O F TIGAR
TIGAR'D Internet: w w tigard- or:gov �t t ntNG DIVISION Noafieed/Method � S l� Supplemental Information
1 I • TYPE O ORK FEE' SCHEDULE
El New construction ❑ Demolition For special information use checklist:
Description J Qty. i Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
. C4TE OF SFR (1) bath 312.70
® 1- and 2- family duelling ❑ Commerciallindustrial SFR (2) bath . 437.78 I
SFR (3) bath : 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 1 25.02
❑ Master builder ❑ Other:
Fire sprinkles ( sq. ft) Page 2
JOB SITE: INFORMATION AIS1) LOCATION Site utilities:
Job site address: s . q Li Sit) , , .f tri e 1�1 ( ` j DA_ Catch basin or area drain 18.76
Drywall, leach line, or trench drain 18.76
City /State/ZLP: '! f `,in ct n �. 9 %
J . *p Feotine drain (rte. linear ft.: , ) Page 2
Suite/bldg. /apt. no.: Project nary h 5
J Y1 f j.�-t?, t t,� (!1 `7 Manufactured home utilities 50.03
Cross street/directions to job site: s• G �1 -54 -, 1 Manholes 18.76
Su: SI,L; y r ,,_# C.tei� S.m 2=t• ---, . v.),`. - i Rain drain connector 18.76
I15 t rd i Sanitary sewer (no. linear ft: •_) I Page 2
L
Su lAnn men v t w -, c;�.u::-t
- s torm sewer (no. linear -I: ^) I Page 2
• Water service (no. linear ft.: ) I Page 2 •
Subdivision: Pryl lnp 1rd- e Acj‘:Atc Lot no.: (a Fixture or item:
Tax map /parcel no.: ( S. )> Le Backflow preventer x 31.27 31.27
DESCRIPTION OF: Vi'OR Backwater valve 12.51
_ ckw 1
°� B a
Clothes washer 25.02
Landscape Irrigation Bacldlow Device
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump ! 25.02
,: ® P ROPER T Y OWNER ❑ TENANT Expansion tank 1 12.51
Name: StoneBridge 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!StaterZIP: Lake Oswego, OR 97035 ?lose bib 25.02
Phone: ( ) Fax: ( ) ice maker 12.51
®:PPLICAN Interceptor/grease tra ZS 2
,. ®;C O.NTACT : PERSON -; trap
Business name: Landscape Oregon, Inc. Medical gas (value: S ) _ Page 2
Primer 12.51
Contact name: Ellen Sparrow o
Roof dram (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 Tublshowerlshowerpan 12.51
E -mail: ellen landscapeoregoa.com Urinal 25.02
CONT12ACfOR Water closet 25.02
:.-
Water heater 37.52
Business name: Landscape Oregon, Inc. Water piping/DWV 56.29
Address: 12200 SW Myslony Road Other: 25.02
City/ State/ZE': Tualatin, OR 97062 Subtotal 31.27
one: (503) 692-5945 Fax: (503) 692 -0768 Minimum permit fee: $72.50 72.50
�C$ Lic.: 7804 Plumbing Lio. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) : 8.70 /
Authorized signature;/ •L..Z, .i ? _.. 2 6:/2/1C
C �c1 TOTAL PERMIT FEE , 81.20 ✓
Ellen Sparrow Datc: 1 jjjj �
This permit appl expires if a permit is not obtained within 180 days
Print name
i7 / j 1 ' c f i after it has been accepted as complete.
• Fee methodology set by Tri- County Building Industry Service Board.
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