Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00240
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/26/2011
Parcel: 2S109DA14900
Jurisdiction: Tigard
Site address: 15326 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 68 Subdivision: Lot:
Project Description: Backflow for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
12200 SW MYSLONY RD 15326 SW SUMMERVIEW DR
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -5945
PHONE:
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/26/2011 $31.27
Specifics: 1 12% State Surcharge - 07/26/2011 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 07/26/2011 $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: '
C. 03.63 9.4175 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.
PlumbinE Permit Anplicatigp ll ,
Building Fixtures e $ FOR OFFICE USE ONLY
City of Tigard JUL 2 2 2011 Received -74 Permit No.: »'
- ,t 13125 SW Hall Blvd., Titrard, OR 97223 / /� �
° Plar, Review
Phone: 503.639 4171 Fax 503.5 B i tF r A Other Permit No.:
Date,B
Inspection Line: 503.639 75 D , Ready/Sy: Ions:
'TIGAILD Date R
Internet: www.tigard -or,gov �U1 L��p�1� r C,r p e H See Page 2 for .
IV Notified/Method: 1 �p, Supplemental Information
TYPE OF"�'F'ORK ; ..: ; . _ _ _. ' FFF *- SCHEALf - .. . • ❑ D emo ....... -- ............ ... • ::... .,.
® New construction Demolition For special information use checklist
Description I Qty, I Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
TEGOR1 OF Ci0 NSTRUCTION , SFR (I) bath 312.70
® 1- and 2- family dwelling I ❑ Commercial/industrial SFR ) bath 437.78
❑ Accessory building El Multi-family SFR (3) bath 500.32
Each additional bath/kitchen I 25,02
0 Master builder [] Oth
Fire sprinkler ( sq. ft.) Page 2
' _ JOB SITE'hi JFORMATIO\' AYD LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
1 S3 2-(i; �i.,v S - Lc.rYtMe_4 i D_ .
Dtywell, leach line, or trench drain 18.76
City / State/ZIP: - 7` 1 G1' „C.L- 0 (2.,_. Gj 7 �.-1 Footing drain (no. linear ft.: ) Page 2
Suite/bldgiapt. no.: J ''[ I Project name:/ -y / i fr Cj -/C1l ( ' Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
•
S -LA.--' i..1,(2.-- la. pt (Z aj i? t,91 ot4 Rain drain connector 18.76
S Lt S Li i rvv -r d te p 2i . Sanitary sewer (no. linear ft.: ) Page 2
oG i L t Storm sewer (no. linear ft.: ) Page 2
1 -\ Water service (no. linear ft,: ) Page 2
Subdivision: fl i 1 t1,61 f -zfy) /4GLG l•1, Lot na : Lj Fixture or item:
Tax maptparcel no.: J Backflow preventer x I 31.27 31.27
.... - _ _ : I Backwater valve 12.51
=: _ :,: :., ..: DESCRIPTCON OF_ VFORK:' _ - I
Clothes washer 25.02
Landscape Irrigation Backilow Device Dishwasher 25.02
• Drinking fountain 25.02
Ejectors /sump 25.02
" PROPERTIC OWNER' -=' - • : TENANT - Expansion tame I 12.51
Name: StoneBridge Homes NW LLC FixturJsewer 25.02
Floor drain/710M 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
• : :.� 'APPLICANT _ : - • = : ! : ; _ . Interc tor/ cease trap s. n
. ,.. 'El PERSON • ep B P 2- 0_
Business name: Landscape Oregon, Inc. Medical as (value: S ) Page 2
Primer 12.5]
Contact name: Ellen Sparrow
Roof drain (commercial) 12.53
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 I Fax: : (503) 692 -0768 Tub /shower /shower pan 12.51
E -mail: ellenglandscapeoregon.com Urinal 25.02
Water closet
-_...- CONTRACTOR:: _ ::. • . .
" Water heater 37.52
Business name: Landscape Oregon, Inc. Water pipinelDWV 56.29
Address: 12200 SW Myslony Road • Other: 25.02
City: State /ZIP: Tualatin, OR 97062 I 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% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized si ture'
!':� t " ; >S,I2G[.'✓t -l) -' _ +y TOTAL PERMIT FEE I 81.20
Print name: Ellen Sparrow Dat'�el! / ' . - L , J
-�-' ! This permit application expires if a permit is not obtained within 180 days
`1F r I after it has been accepted as complete.
'Fee methodoloey set by Tri- County Building Industry Service Board
I PermtApp.dec Ivol /Do 440.4616T(I0/02/COM/WES)
I. 89LO liell3 B617:90 l. 1. ZZ Inf