Permit CITY OF TIGARD PLUMBING PERMIT
D � COMMUNITY DEVELOPMENT Permit #: PLM2011 -00258
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/12/2011
Parcel: 2S 109 DA15600
Jurisdiction: Tigard
Site address: 15346 SW GREENRIDGE PL
Project: Arlington Heights No. 3, Lot 75 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 75
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
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
Type of Use: SF 41 ea Minimum Fee Adjustment - 08/12/2011 $41.23
Class of Work: OTR Plumbing
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 Notifi . '- • enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0090. You may obtain a copy of the rules
or direc • estions to O. NC by calling 503.232.1987 or 1.800.332.2344. �c
Issu d By: / , Permittee Signatur -- C //
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
City of Tigard
Received
� 1 DatelBy S �( 4 Mill PermitNv.: G17�Qlf�Ool D
13725 SW Halt Hlvd., Tigard, OR yam � 1 k \ P ate Review
Phene: 503.639,4171 Fax: 503.593.196'0 PUCj Other Permit No,: 1�sr�u QDIdY
Date,By:
TIGARD Internet:
Inspection ww ti l ard or9 4l7o It l _ . kt) I Date ReadyfBy': luny. L See page : for .
g . ( % t ,nt(t �NotiaedMethod: Supplemental rnfarm
,: _ _ . - .:_ TYPE 'OF: '.*(mik tai -' % . t`u . _ ;_ FEE * SCHEDULE::'- ::.... ,
New construction ❑ Demo t°,', t4 �r Itton For special information use checklist
Description I Qty. 1 Ea. I Tota: _
CI Addition/alteration/replacement ❑ Other: New 1 -2- family dwellings (includes 100 f for each utility connection)
-., t ._. _ - .: CATEGORY' :OF• CONSTRUCTION . _ S. R (1) bath 312.70
® 1 - and 2 - family dwelling 0 Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500,32
❑ Accessory building ❑ Multi family
Each additional bath^dtcher. 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) I Page 2
- JOB SIT ` LOCATION - - Site utilities:
.
Job site address: ( S,3 L/ 6...., Stu l���C,e/wrl ci t�, pia(c . Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /StatelZIP:
Footing drain (no. linear ft.: _) I Page 2
g J
Suite/bld .r aP no.: t. Project name: �'Y - (I I'1 L i f��') 7 � �/ 1 Manufactured home utilities 50.03
�> -
C. street/directions to job site: Manholes 18.76
�L(..) w ( - t v \, nil c_.1/- c_.1/- u i �� a u1 Rain drain connector 18.76
Y Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
�/�,/ Water service (no. linear ft.: _) I Page 2
Subdivision: / - I J ' / j , - j f 1 Y) / 9h.. S I Lot no.:' ?5 Fixture or item:
Tax map /parcel no.: 6, JJJ� J� l� / Backf]ow preventer x I 3 L27 31.27
- • 4/f
- a - Backwater valve 12.51 i
� • - - DESCRII'T10N OF WORK _ w ater , .__
Clothes washer I 25.02
Landscape Irrigation Backflow Device
Dishwasher 25.02
Drinking fountain 25.02
Ejectorsisump 25.02
;:- .- •,. . ._ : _ .: ...:: :�.. _:_ . ._. _. ;.. T:. ..
AN:'. Expansion tank
E'_•: . ,: ®:.PROPERTY D1'V'�ER::: ❑: TENANT
Name: StoneBridge Homes NW LLC Fixture /sewer cap 25.02
Address: 16869 SW 65' Ave #505 Floor drain boor sinkhub 25.02
Garbage disposal 25.02
City/State /ZIP: Lake Oswego, OR 97035 Hose bit 25,02 ,
Phone: ( ) - Fax: ( ) Ice maker 12.51 '
21' .4PPLIC.4.iNT.. ' -, -,: :: s ®
CDV"CACT .PER30N= ; �?;: Interceptorlgrease trap 25.02
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 I Sink/basin/lavatory 1 25.02
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 1 62.54
Phone: (503) 692 -5945 Fax: : (503) 692 -0768 Tub/shower /shower pan I 12.51
E -mail: ellen@landscapeorego n.com Urinal 25.02
_
CONTRACTOR
a er ea er •
_... 'Water set
.... - ,'._.. .. -- .- ._,... W t h t
37.52
Business name: Landscape Oregon, In c. Water pipir_grDWV 1 56,29
t drress: 12200 SW Myslony Road Other: 25.02
0 4
City/State/ZIP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee. 572.50 72.50
Plan rcvicw (25% of permit fee)
CCB Lic.: 7804 I Plumbing Lic. no.: State surcharge (12%ofpermit fee) 8.70
Authorized sirntature Lien (20, /Z.JL.L) TOTAL PERMIT FEE 81.20 „�,/
Print name: Ellen Sparrow ! J Dater i t d. I l This permit application expires if a permit is nut u lrtained within 15D darn 7Y'
after it has been accepted as complete.
'Fee methedo(ogy set by Tn- County Building Industry Service Board.
t:',Build ir.g\PermitstPL,\:t1- Permit App.do: I DC L199 440 45167(1C/i5!COM/WLO)
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