Permit CITY OF TIGARD PLUMBING PERMIT
1111
B COMMUNITY DEVELOPMENT Permit #: PLM2012 -00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2012
Parcel: 2S109DA15000
Jurisdiction: Tigard
Site address: 15340 SW SUMMERVIEW DR
Project: Arlington Heights No 3, Lot 69 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 69
Project Description: Landscape Irrigation backflow device
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
12200 SW MYSLONY RD 16869 SW 65TH AVE #505
• TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 692 -5945 PHONE:
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount L
1 ea Backflow Preventer 05/04/2012 $31.27
Specifics: 1 12% State Surcharge - 05/04/2012 $8.70
Plumbing
Type of Use COM 41 ea Minimum Fee Adjustment - 05/04/2012 $41.23
Plumbing
Class, of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
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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 NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signatur . •
� � / �
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 ApplicatioRECEIVED
Building Fixtures FOR OFFICE USE ONLY
MAY - 2 2312 Re ceived Permit No.: "lay 'o� a - oiu3
Cit of Ti i Date/B - 6- / el /�
e 13125 SW Hall Blvc., Tigard, OR 97 �
i o . Phon 503.639.4171 Fax: 5003.59 1 OF TI GARD D Plan REM eJ " Othe • Permit No.:
Inspection Line: 503.639.4:75 BUILDING DIVISION Date Ready/By: twig: 0 See Page 2 for
TIGAF:D Internet: www.tigerd or.gov Notified/Method Supplemental Information
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For special information use checklist
® New construction ❑ Demolition Description I Qty. I Ea I Total
0 Additioaial emtio /replace-nent ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection) -
[ 'A "-= - A'...'.-'-'-•-.:"'•!, .at_, L .... 1Ty:.:., = SFR (1)bath 312.70
- CA 'T�C.ORYO�!,� C6�151�UC�IQI�p -� - -_ ? �s;:•._ : - .
7: 'T,,. _., :.. ? : ::'' _ ; '
SFR (2) bath 437.78
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (3) bath 500.32
❑ Accessory building 0 Multi - family Each additional bath/kitehen 25.32
❑ Master builder ❑ Other: Fire sprinkler (__ sq. ft) Page 2
1. f 6 ` � ::J Site utilities:
;5 ., ... _ - ; , •ItM�TIO „`1?? LOGAT](Q..... ,,,: ._
, ...- _..., . ,. . ,,: .._ - . Catch basin ex area drain 18.76
Job site address: � s 33 1(0 s- ( C .tti� ».�. i C.L p rC L% 'e Unnsell, leach tine, or trenfi drain 18.76
City/State/ZIP: 7 t-CL - /7__ 2 1 7 / - Footing drain (no. linear 8.: I Page 2 1
Suite/bldgJapt. no.: Project name: �l )1 v ei -6 L Menufa.ittued home utilities 50.03
Crass street/directions to job site: I Manholes 18.76
C�"�
Rain drain connector 18.76
Stu ► 3 'C.l1. .r:t !t'-p Stt.JYt lti ! e� 0 2• Sanitary sewer (no. linear ft.: Page 2
- Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) . Page 2
Subdivision: inciter-4. 61 S I Lot nob/ Fixture or Item:
Tax map /parcel no.: to J A- Sat Sow presenter x 31.27 1 31.27
Backwater valve 12.51
S I ° ,iiµ -- ' 1 : `DE .: 49Z` OF 0 ;`-` :,. :`?if. . - : ar;,r.:[,:: washer 25.02
_FI•,a.Liiy4t m. -r.:P�Gii,. ;CFI. "r' - .• ., Clothes a5
Landscape Irrigation Bacltliow Device Dishwasher 25
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Drinking fountain I 25.02
' Ejectors/sump 25.02
.:,e. _:� � -'' Ex pansion tank 12.51
- - - OPEIt *V: : i!1!IER = fix a ,: = ! _ .. .:ffi;T1rNANT .= - M i .
.: l
IR ah. �5,
is ;'-..:,. ,. �._e . ':iii'. _ =w' �,
_. _ ... . , ,. .. 25.02
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... - ' �. ,..,,. „ "�,:- �, -.... � Fumt ewer cap
Name: StoneBridge Homes NW LLC Floor drain/floor sinkahub 25.02
Address: 16869 SW 65 Ave 1x505 _ Garbage disposal 25.02
City/State./ZIP: Lake Oswego, OR 97035 Huse bib 25.02
Phone: ( )
Fax: ( ) Ice maker 12.51
_ _ _ _ __ ..h: , _ :;•;''';; . ! % I c _.._ T :_. •.' i :�F Interceptor/prase trap 25.02
=��� �1:' r _ - '::; _ _ --" �; _.• ® .Cfjl\�;A4'f(:k'ERSOI!k_.`:: - -=
- Medical gas (va:ue: S ) Page 2
Business name: Landscape Oregon, Inc.
Primer 12.51
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Contact name: Ellen Sparrow Roof drain (commercial) 12.51 0
Address: 12200 SW Myslony Road Sink/basin/lavatory 1 25.02
CityiState /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 - 5945 Fax: : (503) 692 -0768 Tubiahower/shower pan 12.51 .
-
. Urinal 25.02
E -mail: ellen®laadscapeoregon.eom Werner closet 25.02
�1i • i "; - ti' 2 i 37.52
+': fi0erheater
=' I >- 32:1', :.----14;c:;;!_, ':r = �= : F`T -' . - . r % ':5• ^''r - - Re -- :. _
Business name: Landscape Oregon, Inc. Water piping/DWV 56.29
Address: 12200 SW Myslony Road Other. t 25.02
-- Subtotal 31.27
City /State /ZIP: Tualatin, OR 97062
Minimum permit fee: $72.50 72.50
Phone: (503) 692-5945 Fax: (503) 692 -0768 Plan review (25% of permit fee)
CCB Lic.: 7804 ' I Plumbing Lic. no.: State surcharge (12% of perrrit fee) : 8.70
Authorized signature: /9f7 r�, C2i1/l,ttL -1 TOTAL PERMIT FEE 8120
Date 5/ D This permit application expires if a permit is not obtained within 18D days
Print name: Ellen Sparrow / after it has been accepted as complete.
"Fen methodology set by Tri County Building LFdustry Service Board.
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,.;o..:,��.,......■•.1 -$ VI I_P..rn, Am me IGO 1109 440.46 :6T(10102 /f:OM114•EB)
6'd 89LO Z69 - £O9 Ueli3 e8Z :0 l Zl ZO Aeij