Permit CITY OF TIGARD PLUMBING PERMIT
II I ' COMMUNITY DEVELOPMENT Permit #: PLM2012 -00046
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/02/2012
Parcel: 2S109DA17400
Jurisdiction: Tigard
Site address: 15351 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 103 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 103
Project Description: Backflow for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: COLUMBIA STATE BANK
12200 SW MYSLONY RD BY JECK, AL
TUALATIN, OR 97062 17800 SE MILL PLAIN BLVD, STE 10
VANCOUVER, WA 98683
PHONE: 503 - 692 -5945 PHONE:
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 03/02/2012 $31.27
Specifics: 41 ea Minimum Fee Adjustment - 03/02/2012 $41.23
Plumbing
Type of Use: SF 1 12% State Surcharge - 03/02/2012 $8.70
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: (�
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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.
Plumbing Permit Application
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Building Fixtures
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FOR OFFICE USE ONLY
lilig City of Tigard ti Received
a 13125 SW Hall Blvd., Tigard, O 7 ,•' < r elB : �� ! `� :
= !bane: 50 .639.4171 Fax 5v3. '' :. � • kin Review
Inspection Line: 503.639,4175 ‘V's , \GQ` S �� ii B Other Perait o.;
TlGnR.� Internet www.cigard-or.gov
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r -. s,.,_ _ _ = Supplemental Information
ate
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atifed eth
TYPE' OF V4'ORK' :, : :: ' . I
i
- ......__. ... :� _..,..:=- . - - - - _ - - EE's "� - - - -
® New construction • El Demo `v • :: For special Information use checklist
Description ❑ Addition/alteration/replacement - �Qt ] Ea Total
-• .._ : .:.. " - _ - $ for each utility connection) ::. _ --- �...... - �...,_.._.. � ❑other•
:_.: -. 1 7 - :•;'-•- CAkTE 01 COIVS r,_ ..v.. :•a - -
.. ,• :. . . .._ ... - _
. d dwellings (includes i 00 v
® 1- and 2- family dwelling ❑ Commercial/industrial r SFR bath SFR (2) bath
437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
O Each additional bath/kitchen 25.02
❑ Master builder I
)
... - -
.., - -- - - - - get
Job site address: 1 53 57 S' LA-rr� n i -.'b� ! C�_c.) nit_
Catch basin or area drain 18.76
City/State/ZIP: y-( QA_ 0 2 (7 12 .2-;)_ Drvwell, leach line, of trench drain 18.76
Suite/bldg./apt. no.: Project name -� / n � Footing drain (no. linear ft.: _) Page 2
5 *71 J il_ t'S' Manufactured home utilities 50.
Cross street/directions to job site: J Manholes 18.76
6 e ' I -/l GL R.p .- - LN tut fry-L17) Rain drain connector 18.76
6-72 ef7 fj rte: :(, Dg- --=2 P to Sanitary sewer (no. linear ft.: ) Page 2
�U -114fr .2. {J I (-14_, DR- i id-e___,
sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) p
Subdivision: ffrlin 9 frn if q / I Lot no.: /63 Fixture or item: age 2
Tax map/parcel no. Cj o preventer x
:;... :�..; .,,.. -- - - � 31.27 •
.. -_ ... .
. _ ".... n .- : : : : _; . _ : :__ - - - - - ter valve
. :.. :. -- CRI . - _
ac 1251
Landscape Ira ration Backflow Device Clothes washer 25
Dishwasher 25.02
2
Drinking fountain 25.02
Ejectors/stunp 25.02
_:. : , ... ^ PROPERTY :OWNER; ; : ;.: S -_ . .
:. : ,.: •::;I ' _ :_. ❑,�TENa3VT,- ° Expansion tank 12.51
_Name: StoneBridge Homes NW LLC Fixture/sewer cep 25.02 •
Address: 16869 SW 65 Ave #505 Floor drain'iloor sink/hub 25.02
City /StateIZ P: Lake Oswego, OR 97035
Gar
Hose b e disposal 25.02
Hose bib 25.02
Phone: ( )
: - -•.:= �, : ; Y: _ - - - _ _ _ maker
•
!: ::. , ,. , ,,, i APPLICANT : :::; -r .! ; . - _ y t ". •
" .... =�"'� _ ..CONTACT 1 'ERSUh- ; .,, ;. : -• lnteraptor /gttase vep 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: S ) Page 2
•
Contact name: Ellen Sparrow Primer 12.51
Roof drain (commercial) 12.5I
Address: 12200 SW Myslony Road
Sink/basin/lavatory 25,02
City:!State'ZIP: Tualatin, OR 97062 Sour units (potable water) 62.54
Phone: (S03) 692 -5945 I Fax: : (503) 692 -0768 Tub/shower/shower pan 12.51
E- mail: ellen@landscapeoregon.com Urinal 25.02
t��....., : ._ :... :,... . _.._._� .. : - :. >.� = : CO J, V T Zi . ► L1OR _ -7'. _ _ _ -- _ F, yti : 25.02 • Water closet
2
data beater 37.52
Business name: Landscape Oregon, Inc.
Water piping/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: S72.50 72.50
CCB Lic.: 7804 Plumbing Lic. no.: Plan review (25 %ofpermit fee)
Authorized signature State surcharge (12% of permit fee) 8.70
�� " / G � , ' L� '� -� i TOTAL PERMIT FEE • 81.20
Print name: Ellen Sparrow I Date:3 -,2 - /; I This permit application czpires if a permit is not obtained within 180 days
atter it bas been accepted as complete
"Fee methodology set by Tri- County Building Industry Service Board.
t :1BulldinsTenn itrlP[.tdtl- PermliApp.tx io.uLe9 440.4416t(10J021Ca.MAVEB)
Z'd 89LO Z69 - £09 Uell3 Et l:60 Z ZO JeW