Permit CITY OF TIGARD PLUMBING PERMIT
>9 ' COMMUNITY DEVELOPMENT Permit #: PLM2012 00282
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 2S109DA15200
Jurisdiction: Tigard
Site address: 15378 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 71 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 71
Project Description: (1) backflow preventer
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 4230 GALEWOOD ST SUITE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 -692 -5945 PHONE: 503 387 -7577
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/26/2012 $31.27
Specifics: 1 12% State Surcharge - 09/26/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 09/26/2012 $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: ‘11U4/1-- Permittee Signature:
Did AM,/ i�,4 t 1 L)kL
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. f
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 nr,,rt,„,ivFa
q Building Fixtures `'`" FOR OFFICE USE ONLY
C i t y of Tigard S E P 2 6 2012 Date- Q a - ( i ( e „ r - Permit No.: p ( , i i i a p a ce oo
• 13125 SW Hall Blvd., Tigard, OR 97223 plan Rerew Other Perm :1No
11111 e ; - Phone: 503.7182439 Fax: 503.598.1960CiTr- Tia,�lRd l)at: :73y lu sTo�Ol,a-�1��
T I GARD Inspection Lire: 503.639.4175 °Q 1 f I t ' ( �i � Reaay /By: -kris: 0 See P age 2 for 1 Internet: www.tigard- or.gov .d .,� 1 JJ I� tNntitied I�iethod: TIC. Supplemental Information
_ - TYPE: OF wORK .. -.. FE . SC _ _ _. •
® New construction 1 ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement f ❑ Other: New 1- 2- family dwellings (includes 100 P.. for each utility connection)
_. - CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 50032
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (__ sc. ft.) , Page 2
_ . :OB SITE INFORMATION :ANA.LOCATION,a : - Site utilities:
r Catch basin or area drain 11.76
Job site address: i , r 7 g S,L Lt-n m t -tip l , --4 - 2. , Ott D vw eil. leach line, or trench drain 11,76
City /State/ZIP: - l A,LC� 0 C, .3:-
7
U Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg./apt. no.: 1 Project name: /9- l rl j '
M anu f actured Ironic uti:ities 50.03
Cross street/directions to job site: Manholes 18.76
(3 E' e.F• 13e/Let izo Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
• Water service (no. linear ft.: ) Page 2
Subdivision:A-I- / ! R i fit- 14EL. Ji 5 1 Lot no. :7 I Fixture or item:
Tax map/parcel no.: (es-5- a ( Backflow preverter x 31.27 1 , 31.27
:: . . DESCRIPTION OF WORK - Backwater v e
Clothes washer 25.02
Landscape Irrigation Back Flow Device
Dishwasher 25.02
Drinking fountain 25.02
•
Ejectors/sump 25.02
. PROPERTY 9viNEi<t'i :;_:: a ; : =i_: ❑ = TEN.4I9;. ; .. : : :r Expansion tank 12.51
Name: Stone Bridge Homes [CV/ LLC
Fixturesewer cap i 25.02
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood Street Suite 100
Garbage disposal • 25.02 •
City/State/ZIP: Lake Oswego, OR 97035 _ Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
APPLICANT;` _ '..i_,° • ; ; :•; •.: 1 . r&COLN1'ACZ PERSON .. -: htterceptorlgeasc trap 25
Business name: Landscape Oregon, Inc. Medical gas (value: S ) Page 2
Primer 12.51
Contact name: Ellen Sparrow
Roof drain (commercial) I 1 51
Address: P.O. Box 2386 Sink/bcsinrlavatory I 25.02
City /State/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax: : (503 -) 692-0768 I Tub/shower:shower pan I 12.51
E -mail: ellen@landscapeoregon.com Urinal 25.02
ea
Water closet 25.02
OR - -
: !..CONTRACT. - _ Water beater 37.52 •
• Business name: Landscape Oregon. Inc Water piping/DWV 56.29
Address: P.O. Box 2386 Other. 25.02 •
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 review (25 %o= permit fee;
CCB Lic.: LCB 7804 Plumbing Lie. no.:
State surcharge (12% of permit fee; 3.70
Authorized signature: _y ) _et t.,Lat.J . TOTAL PERMIT FEE i 81.20
Print name: Ellen Sparrow I Dat f / This permit application expires if a permit is not obtained within 180 days
� . /r� after it has been accepted as complete.
I , t
'Fee methodology set by Tri-County Building Industry Service Board.
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