Permit n CITY OF TIGARD PLUMBING PERMIT
, . a .. COMMUNITY DEVELOPMENT Permit #: PLM2013 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2013
Parcel: 2S109DA18600
Jurisdiction: Tigard
Site address: 12758 SW WILLOW POINT LN
Project: Arlington Heights No. 3, Lot 115 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 115
Project Description: Install residential backflow preventer for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW
PO BOX 2386 4230 GALEWOOD ST, SUITE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97034
P
PHONE: 503 - 387 -7577
PHONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/14/2013 $31.27
Specifics: 1 12% State Surcharge - 02/14/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 02/14/2013 $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 NC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: /� . , / Permittee Signature: / /` Ce'' (� J
•
' ` 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 ApplicationRECEIVED
Building Fixtures F F B 1 3 2013 FOR OFFICE USE ONLY
City of Tigard Received 13 of / 3 /5 �� j permit r,o.: a tt(p. /3 -ODt,�
V 13125 S W Hall Blvd., Tigard, OR 97Q#TY OF TIGARD Mao Review
Dote 3y^ Other Permi No.: ) i7 / 3 .0 5
NI � Phone: 503.7182439 Fax: 503. � tb
Inspection line: 503.639.4175 g ING DIVISION [}cite R chill :
Internet www.tigard-or.gov 6 0 See cmc Page tal :for
TIGARD -or.gov Notified/Method: / l
Bard � Supplalaformatioa
. - „
__ TYPE OF WORK _ ` FEE_ _, SCHEDULE- ;
El New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
- - ` ' SFR (1) bath 312.7
-. - - L. . _CATEGORY OF :GONSTR[fC170N
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.73
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bathikitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler (__- -_ sq. ft.) ! Page 2
_JOB SITE: LYFORMATION AND LOCATION _ Site utilities:
Job site address: / !'75 i . I ) t 12- � Ly) Catch basin or area drain 18.75
Drywell, leach or trench drain 18.76
City /State: '-i) G ,%/i%L 612 ei ?'c. -L
Footing drain (no. linear ft.: _) Page 2
Suite/bldgJapt. no.: i f f Project name f, y-1y /' /) S Manufactured home utilities 50.03
Cross street /directions to job site: Manholes I 18.76
l /1 V - / C - 4 - A - 3 r i - / `
�� I.k Rain drain connec :or 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) j Page 2
Water service (no. linear ft.: _ ) Page 2
Subdivision J,-1 p. �C'.e.9 /'L7l 1 Lot no.: (/ .5 Fixture or item:
Tax map /parcel no.: t ! SS - 4- Backflow preventer x 31.27 3127
_.. ''';'f,::: ,.D. -- - - = valve _ :: ESCRIPTI079 O - .
; Clothes washer 25.02
Landscape Irrigation Back Flow Device Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTYI OWNER ... : : ,_ ❑ TENANT e ; Expansion tank 12.51
Name: Stone Bridge Homes NW LLC Fixture/sewer cap 25.02
Floor drain/floor sinklhub 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
A PPLICANT . ; :'; _ -._
-. . .® C ONTA CT PERSON '� ; ! : : ersr�tovgrease
Medical gas (value: $ ) Page 2
Business name: Landscape Oregon, Inc.
Primer 12.51
Contact name: Ellen Sparrow Roof drain (commercial) 12.51
Address: P.O. Box 2386 Sink/basin/lavatory 25.02
City/State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692.5945 Fax: : (503 -) 692 -0768 Tub/shower /shower pan 12.51
E -mail: ellen @landscapeoregon.com
Urinal 25.02
Water i
a er c oset - .
COPT I RAC COR -;
Water heater 37.52
Business name: Landscape Oregon, Inc. Water piping,'DW V 56.29
Address: P.O. Box 2386 Other: 25.02
CitylState/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% of permit fee)
CCB Lic.: LCB 7804 Plumbing Lic. no.: State surcharge (123/0 of permit fee) 8.70
Authorized signature _Lem �A 2,1..t:.J TOTAL PERMIT FEE 81.20
i Print name: Ellen Sparrow This permit explresif a permit is not obtained within 180 days has Date :y 3/ j1 after it h been accepted as complete
*Fee methodology set by Tri- County Building Industry Service Board.
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