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Permit CITY OF TIGARD PLUMBING PERMIT 11 q COMMUNITY DEVELOPMENT Permit #: PLM2012 -00360 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/11/2012 Parcel: 2S109DA15400 Jurisdiction: Tigard Site address: 15272 SW GREENRIDGE PL Project: Arlington Heights No. 3, Lot 73 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 73 Project Description: (1) backflow device Must maintain 5' side yard setback and approved rear yard setback Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES PO BOX 2386 4230 GALEWOOD ST., STE. 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 12/11/2012 $31 27 Specifics: 1 12% State Surcharge - 12/11/2012 $8 70 Plumbing Type of Use: SF 41 ea Minimum Fee Adjustment - 12/11/2012 $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: titt�l/1 Permittee Signature: © d ,Q PPt i e ' l (� Call 503.639.4175 by 7:00 a.m. for the next available inspection date. I /'(/ v 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 E C ApplicatioRE VE Building Fixtures �t ��JJ tL..,,rr FOR OFFKC1: USE O' 1.1 1 1 2012 Received � 1 �- P e r m i t wi 722 m Phone: 503.718.2439 Fax: 503.5980 Of TIGARD 1 Plan Review y, Other Permit No.. I D�te;9 r 1 ri A R n Inspection Line: 503 BUILDING DIVISION Date ReadyBy .1 - n 1� See Page 2 for Internet www.tigard-or.gov Mit:ISea/Me :hod j (� Sutiple nrcn[a1 rnriwiunllun - TYPE: OF WORK FEE* SCHEDULE.. . 21 New construction ❑ Demolition For special information use checklist Dcscnption I Qty. E. I Total ❑ Additionlolteration /repIacement ❑ Other: New 1- 2- family dwellings (inchides 100 ft. for each utility connection) _ R (1) bath 312.'0 CATEGORY OF CONSTRUCTION " . " SF R- ® 1- and .- family dwelling ] Commercial/industrial SFR(2) aath 437.78 ❑ Accessory building ❑ Multi - family SFR(3) bath 500.32 Each ad::itiorral bath/kitchen 25.02 ❑ Master builder ❑ Other: Frrc sprinkler sq. ft.) Page 2 ' JOB SITE INFORMATION AND IOCC TION Site utilities: Job site address: j S . 7 a LL L J2 e - - ` � ( <<C c Catch basin or area drain 18 -76 City!State/ZIP: ?` J Cra. Ac OR.-- el '7 7'-- D oting r each io l n e eft.: drain 18.76 Page 2 Footing drain (no, linear ft: ) Page 2 Suite/bldg.iapt no.: V I Project namo14-1•j (1'1) h' '73 Manufactured home utilities I 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 I 5 ill.; Grt l i ci e- c , P h Gt C L Sanitary sewer (no. linear ft.: _ , _ ) Page 2 1 Storm sewer (no. linear ft.: _) Page 2 1 • Water service (no, linear ft.: ) Page 2 Subdivision: Al' j 1 i'lq . .i l 1 >- I Lot no.: ') 3 Fixture or item: Tax map parcel no.: 6. S /Th 7 Beddow preventer x 31.27 31.27 _ Backwater valve 12.51 - DESCRIPTION OF WORK Clothes washer 25.02 Landscape Irrigation Back Flow Device Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ® PROPERTY OWNER I ❑ TENANT - Expansion tank 12.51 Name: Stone Bridge Homes NW LLC Fixturr/sewer cap 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 ® CONTACT PERSON Interceptorgease trap 25.02 - Business name: Landscape Oregon. Inc Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: Ellen Sparrow Roof drain (cornn:emeial) 12.51 Address: P.O. Box 2386 Sink/basin'lavatory 25.02 Cityi State /ZIP: Tualatin. OR 97062 Solar units (potable water) 62.54 Phone: (503) 692 -5945 I Fax:: (503 -) 692 -0768 Tub/shower /shower pan 12.51 E -mail: ellen landscapeoregon.com Urinal 25.02 @a . 'CONTRACTOR water closet 25.02 Water heater 37.52 Business name: Landscape Oregon, Inc. Water piping!DWV 56.29 Address: P.O. Box 2386 Other. 25.02 I City /State ZIP: Tualatin, OR 97062 Subtotal 3127 Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee: 572.50 72.50 Lie. I Plan review (25% of permit fee) CCB Lic.: LCB ?8D4 t(+ 30 I. Plumbing no.: �' "I t State surcharge (123o of permit fee) TOTAL PERMIT FEE 8 i 8.70 Authorized signature ,l_1 81.20 / C L�v� r I - DBIC 1 This permit application expires.if a permit Is not obtained within IRO days Print name: Ellen Sparrow I r /l d-f aG / after it has been accepted as complete. "Fee methodology set by Tr .'...oanty Building Industry Service Board. t:', Builiirticntiu:PLMU-PernitArp.doe ICOI'09 44- 1616T( :0102.COM(WEa) v d 89LO Z69 - £09 Ueii e££ :60 Z 6 u. oea