Permit ipq CITY OF TIGARD PLUMBING PERMIT
.' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00259
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/12/2011
Parcel: 2S109DA15700
Jurisdiction: Tigard
Site address: 15362 SW GREENRIDGE PL
Project: Arlington Heights No. 3, Lot 76 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 76
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 16869 SW 65TH AVE #505
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
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PHONE: 503 - 387 -7577
HONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 08/12/2011 $31.27
Specifics: 1 12% State Surcharge - 08/12/2011 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 08/12/2011 $41.23
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
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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 scions to • . C by calling 503.232.1987 or 1.800.332.2344.
Issued 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.
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Plumbing Permit Application 503 ,,,���,,,
Building Fixtures a ��: � � ' FOR OFFICE U SE ONLY Vo
71 C ity of Tigard Rexiwed g / �
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a 13I25 S W H Bl v d ., Tigard, 0j97223 i� O� � DateJBy: g / _ i � I
`� 98 T' Plan lievicw'
Phone: 503.639.4171 Fax: 50 Inspccdon Li .%598"1960 1 Daz OtherFo,mi- No.:�l6aVi Qde,f '
Lino: 503.639.4175 v 1 /
TIGAAD 6394175 p� � N; � ,, Dat: Ready13y: luris: E] See Page 2 for .
Internet: www.tieard- or.gov �� y 4•:' , , •f ,_,, �'a ;`ctifiedIMethod: Supplemental Information
TYPE OF . WORK t '. -" ,.'-'4 c7y l yv
❑ Demolit For speci information use checklist
New construction
Description I Qty. I Ea. J Total
❑ Addition /alteration!replaeement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' CATEGORY OF CONSTRUCTION - : : SFR (1) bath 312.70
® 1- and 2- family dwe::ing ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 1 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
- - .:. :'_ 30B SiTE'I�NFORMATIO =AND LOCATION - : Site utilities:
Job site address: (S 3 (P -' � e S L GI (' t%1 a C/ e P a e Catch basin or area drain 18.76
City/State/UP: f ! Drywell, leach line, or trench drain 18.76
f i GL4L� C Q j 7 D-�- - L f Footing drain (no. linear ft.: ) Page 2
Suite/bldg.apt. no.: Project name: /3-y7/ 1
7' ---) g,,."'" Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
/--L S i- nn me-Y' i. L-2.t.0 b r LUt Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no, linear ft.: ) Page 2
�' Water service (no. linear ft.: ). Page 2
Subdivision - - i ( t of ( y) hi-e...4_,9 lis Lot no.: ' <74 Fixture or item:
Tax trap /parcel a no.: (L% A, Backflow Backflow preventer x 31.27 31.27
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I 12.51
DESCRIPTION OF WORK : 13aekwaler valve
ve
Clothes washer 25.02
Landscape Irrigation Backflow Device --
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
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PROPERTY OWNER ,:::; :; -- ❑ :TENANT •
- _ _ . , :' ;
Expansion lank 12.51
Name: StoneBridge Homes NW LLC Fixture'sewer ca 25.02
Address: 16869 SW 65 Ave 01505 L Floor drain/floor sin vhub 25.02
Garbage disposal I 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hcse bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
r ® _ :4.PPLICA_NT _ ; � ® ;,CONTAC_PERSON ': ; . - : ' Interceptorlg:easetrtip 25.02
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Business name: Landscape Oregon, Inc. Medical gas (value: S ; Page 2
Contact name: Ellen Sparrow Printer 12.51
Roof drain (commercial) 12.51
Address: 12200 SW Myslony Road Sinlvbasin/lavatory 2
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Far<:: (503) 692 -0768 . Tub /shower /shower pan 12.51
E -mail: ellen@landscapeoregon.com Urinal 25.02
Water closet
= CONTRACTOR : - • ;a- -
a Water ea, r
X7_ .
-. - , h •e 52
Business name: Landscape Oregon, Inc. Waterpiping,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: 572.50 72.50
Platt review (25% of permit fee)
CCB Lic.: 7804 Plumbing Lic. no.: State surcharge (12% of permit fag) 8.70
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Authorized signature .C' -� ,,,-)_ ;/. Ul-- 2LJC.A J TOTAL PERMIT FEE 81.20 /',
, Print name: Ellen Sparrow I Date: 5 ///x5 - This permit application expires if a permit is not obtained within 180 days V
s l 1� after it has been accepted as complete. VVVV��
*Fee methodology set by Tri- County Banding Industry Service Beare.
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