Permit CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2011 -00288
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 09/14/2011
Parcel: 2S109DA14700
Jurisdiction: Tigard
Site address: 15262 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, lot 66 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 66
Project Description: Installation of residential backflow preventer for irrigation
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
12200 SW MYSLONY RD 16869 SW 65TH AVE, STE 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 09/14/2011 $31 27
Specifics: 1 12% State Surcharge - 09/14/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 09/14/2011 $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 quests OUNC by calling 503 232 1987 or 1 800.332.2344.
Issued B : Perm ittee Signature:
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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.
I
Plumbing Permit Application 4earfrr (,,,
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Building Fixtures FO OFFICE USE ONLY
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3ecciveReceiver: n Y //
- City of Tigard ` � Da, By 7 / -./ Permit Na: P AiipypelRge
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13125 SW Hall Blvd., Ti OR 97223 f PlanRc4�ew
Phone 503.639 4171 Fax 503 598 1960 Date/By: Other Pcrm.t Nc. J,
TEt ARD Inspection Line: 503,639.4175 Date Ready /By Su is p See Page 2 f 0 or
Internet: www.tigard- or,gov NoliftedTdethod• Supplemental Information
TYPE OF WORK - - FEE* SCHEDULE, -
® New construction El Demolition For special information use checklist.
Description I Qty- I Ea i Tool
❑ Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION - SFR (I) bath 312 70
Z I- and 2- family dwelling ❑ Commercialiindustrial SFR (2) bath 437,78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
—
❑ Master budder Each additional bath/kitchen 25.02
O Fire sprinkler (_ se ft
Page 2
JOB SITE INFORNMATION AND LOCATION Site utilities:
Job site address: 1 5 (l . .U - t r ems) t C,(_L-� on` Catch basin or area drain ! 8.76
Drywell, leach line, or trench drain 18 76
City /State/ZIP. 7°`1 Cf , 0 ' 7 ;?
Footing drain (no. linear ft.. ) Page 2
-
Suite/bldg. /apt. no.: l Project name( / I2q La 6, Manufactured home utilities
50.03
Cross street/directions to job site: Manholes 18.76
5 m f(c --LCz_ e.1 ,'f re ,,,- R ain drain connector 18.76
Sanitary sewer (no. linear ft.: 1 Page 2
Storm sewer (no. linear ft ) Page 2
r Water service (no. linear ft.: ) Page 2
Subdivision: , 1' l ) Y2e) p1
li-1 t . i'\--ii Lot no., Le Fixture or item: -
Tax map /parcel no.: (1- /5 5' ft(/' 8ackflow prev x 31.27 f 31.27
DESCRIPTION OF WORK Backwater valve 12.51
, - - Clothes washer 25.02
Landscape Irrigation Backflow Device _
Dishwasher 25.02
' Drinking fountain 25.02
Ejectors /sump 25 12
® OWNER . ❑ TENANT - Expansion tank 12 51
Name. StaneBridge Ilorn N es W LLC Fixhrre'sewer cap ZS 02
Address: 16869 SW 65 Ave #505 Floor drain /floor sirduhub 25,02
Garbage disposal 1 25.02
City /State /ZIP Lake Oswego, OR97035
Hose bib 25.02
Phonc• ( ) Fax: ( ) Ice maker
12.51
El APPL1ICAU\T S. CONTACT PERSON Interceptor /grease trap 25.02
Business name: Landscape Oregon, Inc- Medical gas (value: $ ) Page 2
Contact name: Ellen Sparrow
- Primer 12.51
' Roof drain (commercial) 12,51
Address: 12200 SW Myslony Road Si ilv6asin lavatory" 25 02
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax:: (503) 692 -0768 , Tub /shower /shower pan _ 12.51
E -mail: e!lenalandscapearegon.com Urinal 25.02
- : CONTRACTOR
Water closet 25.02
Water heater 37.52
Business name: Landscape Oregon, Inc. Water piping X629
Address: 12200 SW Myslony Road Other 25.02
CityfState /ZL°: Tualatin, OR 97062 Subtotal I 31 27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee: S72,50 72.50
CC13 Lie.: 7804 Plumb_ng Lic. no.
Plan review (25% of permit fee)
State surcharge (12 %ofpermit fee) 812C
Authorized signature[ /L, JGf -'-- -- -- - TOTAL PERMIT FEE Fi a �� .
Print name: Ellen Sparrow Date T —/ C '- (� This permit application expires if a permit is not obtained wrthiii79t" l
after it has been accepted as complete. +
'Fee methodolo v set by Tri- County Building Industry Sen,ce B
I\Bull dirg\P.rmus'PLIMCT- Pe doc 10/0:/59 4 40- 46t5T(10i02 /COAVE.E)
I, ' d 99LO 269 uell3 dCC:Z6 1. 171, deg