Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00283
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 2S109DA14500
Jurisdiction: Tigard
Site address: 12642 SW MOUNT VISTA CT
Project: Arlington Heights No. 3, Lot 64 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 64
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 - 387 -7577
HONE: 503 - 692 -5945
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: 41-1 0�'C.[f�[il Permittee Signature: n t I 44 r (. 4T/Okt
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 i '
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Buildin Fixtures " t , ,, y FOR OFFICE USE ONLY
City of Tigard S EP 2 6 2012 Rec:ived
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v 13125 SW Hall Blvd., Tigard, OR 97223 y' rG� a(f / ' 2 - �"° `�
Phone 503.718.2439 Fax: 503.598.196 Plan Review Otter emit i:o.
Inspection Line: 503.639.4175
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New construction ❑ Demolition For special Informadon use checklist
Description ! Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
_. - .. .. CATEGORY: OF CONSTRUCTION.? _ . ..: - - SFR (1) bath 31230
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 937.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
1 Each additional bath/kitchen 25.02
Q Master builder ❑ Other.
Fire sprinkler ( sq. ft.) Page 2
- - - • •; ;JO• SIITE- IN FORMATION_: :AN_D.`.'- LOCATIO'.V : `: - : ` ; ' :".. `` Site utilities:
Job site address: /,_ ( Li a mCi,; Lt viS' �,. et ., ,,,-- Catch basin or arcs drain 18.76
Dryywell, leach line, or trench drain 18.76
City/State/ZIP: rjein..'l,�:l o % - 7
1 Footing drain (no. linear R: _ ) Page 2
Stiitelbldg /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Stt-al ( V'l.) 1 e LLD Dr L - 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 Fill 1 p feir - 1..1-[.,4 y /.aS Lot no.:67 if Fixture or item:
Tax map/parcel no.: te SS 61:4. Backfinw pm x 31 _27 I 31.27
:.. _ ....:... _,.,, . , _ ' 'DESCRIPTION OF WORK � - ;' .; : : :; : . :. :.;
ac ti vn ve
__. Clothes washer 25.02
Landscape Irrigation Back Flow Device Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.: .
,_. :;> __® PROPERTY O.W . ; : _ _ _ `_ i . , . O. TENANT: ::; `: ' Expansion tank 12.51
Name: Stone Bridge Homes NW LLC Fixture/sewercap 25.C2
Floor drain/floor sink/hub 25.C2
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
.i., j.d:e '_:. : : :gi AI'PLICA 4T . - . ..iFI ; ... - E1 .CONTACT PERSON r . ;, 2 : : :.. .2' Interceptor.'greasc trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: S _ ) Page 2
Contact name: Ellen Sparrow Primer 12.51
Roof drain (commercial) I 12.51
Address: P.O. Box 2386 Sink/basin/lavatory I 25.02
•
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 I Fax: : (503 -) 692 -0768 Tubishower/shower pan 12.51
E -mail: ellen@landscapeoregon.com Urinal 25.02
25.02
ease
W t heater
37.52
Business name: Landscape Oregon, Inc. Water piping 56.29
Address: P.O. Box 2386 Other. 25.02
City/State/Z1P: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee: 572.50 72.50
CCB Lie.: LCB 7804 Plumbing Lic. no.:
Plan review (25% of permit feel
(j ( � • State surcharge (12% of permit fee) 8.70
Authorized signature t�, �J - -'u _- , TOTAL P FEE 81.2C
Print name: Ellen Sparrow � flat '/ � This permit application cxpires.if a permit Is not obtained within 180 days
I! ` / rJ � y/� � after it bas been accepted as complete.
*Fee methodology set by Tri County Bufding Industry Service Solid.
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