Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00170
T E G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2012
Parcel: 2S109DA18700
Jurisdiction: Tigard
Site address: 12734 SW WILLOW POINT LN
Project: Stone Bridge Homes Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 116
Project Description: Landscape 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
1 ea Backflow Preventer 06/18/2012 $31.27
Specifics: 1 12% State Surcharge - 06/18/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 06/18/2012 $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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: /.1J 0 /1 � f/ vl U 1/1 f /t —J •
•
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. T / i /l j
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 ApplicatioaRCEIVED
Building Fixtures FOR OFFICE USE ONLY
City of Tigard JUN 1 4 2012 Received 1 .7 1 v Apt d. - to !10
Davey: � ` ) O ' � S, Penult
25 SW Hall Blvd., Tigard, OR 9727 r n �. i . jG G / Plan Review f yl a
111
Phone 503.718.2439 Fax: 503598. E Permit N S� a) 'twlpr
natvey:
T I G rl rt D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: ®Sec Page 2 for
Internet: www.tigard -or.gov Notified/Method: V W _ Supplemental Inlorrnntion
::; : TYPE OF WORK . . . _ _ : _ 'FEE! "SCHEDU E _ _ '
® New construction ❑ Demolition For special Information use checklist
Description I Qt I Ea. I Total
0 Addition/alteration/replacement ❑Other. Newt -2- family dwellings (includes 101) ft. for each utility connection)
- -.. CATEGORY OF CONSTRUCT 12.
- ._.. .. ... _::. SFR 1)bath
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.73
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family -
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprink]er / sq. ft.) Page 2
- / dOB SITE INFORMATION AND LOCATION / Site utilities:
Job site address: / . 7 3 e / L-U % dime Pe, l,i LL(_f') e _ Catch basin or area dram 18.76
Drywell, leach line, or trench draw 18.75 ,
City/State/ZIP: - j /may �� c -- 2 , /2_ �j �'-
0 Footing drain (no. linear fr.: _ ) Page 2
Suite/bldg./apt. no.: I Project name: y/ / / -y, // t , :Manufactured home utilities _ 50.03
Cross street/directions to job site: Manholes 13.76
Rain drain connector 18.76
- Sanitary sewer (no. linear ft.: ) Page 2
Storrn sewer (no. linear ft: , ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: i j /-111-1.-7- 4-Lq/t z I Lot no:: !l4, Fixture or item:
Tax map /parcel no.: (p S5 A 7 Bacldlow preventer / 31.27 31. •�7
.. . .. _ ... .. water valve
. . : - DESCRLPTION'OF WORK;•
Clothes washer 25.02
Landscape Backflow Device Dishwasher 25.4E
Drinking fountain 25.02
Ejectors /sump 25.02
_ ® PROPERTY OW1!IER . '.. -: °: ❑ :I . .. : - Expansion tank 12.51
Name: Stone Bridge Homes NW LLC Fixture'sewcrcap 2.5.02
Floor dmin!floor sink/hub 25.02
Address: 4230 Calewood Street Sutie 100 Garbage disposal 25.02
City /State/lP: Lake Oswego, OR 97062 Hose bib 25.02
Phone: ( ) . • Fax: ( ) Ice maker 12.51
.-- ,:: ® APPLICANT- `. =. • ; :.. _::.:..:. CONTACT PERSON . IntesnePLDL grease 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: P.O. Box 2386 Sinkbasinrlavatory 25.02
City /State/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 I Fax: : (503) 692 -0768 Tub/showedsttowerpan 1 1 12.51
Urinal 25.02
E -mail: ellen@landscapeoregon.com
_
._ Water closet 25.02
CONTRACTOR - Water heater 37.52
Business name: Landscape Oregon, Inc. _ Waterpiping%DWV 56.29
' Address: P.O. Box 2386 Other. r , 25.02
City/ State /ZIP: Tualatin, OR 97062 Subtotal
Phone: (503) 692 - 5945 Fax: (503 -) 692 -0768
Minimum permit fee: S72.50 7 Sr)
Plan review (25% of permit fee)
1 /(CB Lic.: LCB 7804 Plumbing Lic. no.: State surcharge (1 2"/0 of permit fee) g `L .f
Authorized signature: TOTAL PERMIT FEE gI e ,
This permit application expires Ifs ermit is not obtained with'. IRO days
[print name: Ellen Sparrow Date' / f l f arisen sus bee ac cepte p d ax complete.
- ir T •Fee methndo:ogy set by Tr' -Couory Building industry Service Brad.
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