Permit CITY OF TIGARD ED PLUMBING PERMIT
1 4 COMMUNITY DEVELOPMENT pl.3111/.11i Permit #: PLM2013 00067
T [ G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/25/2013
Parcel: 2S110CB10700
Jurisdiction: Tigard
Site address: 15498 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 95 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 95
Project Description: (1) backflow device for landscape irrigation 3/6/13 REPRINT permit to correct description
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW
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 02/25/2013 $31.27
Specifics: 1 12% State Surcharge - 02/25/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 02/25/2013 $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 to OUNC by calling 503.232.1987 or 1.800.332.2344. p
Issued By: Aju f ,� , _ f Permittee Signature: /' (/_ Pci e ,n 7---/
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 RECEIVE 1
Building Fixtures 4 FOR OFFICE USE ONLY
City of Tigard 5 201 Received
13125 S Date,Br C7 r 1 3 S� p7 SW Hall Blvd., Tigard, OR 97223
P enult N o.: PUN 13
Phone: 503.718.2439 Far: 503.598.1960t-1 1 i yr nuA LI Plan Revi,,. cv Other Permit No
Inspection Line: 503.639/175
'1G "ARiJ Internet: www.tigard- or.gov BU[LDINGDNISIRertd J ty;3, SeoP /3 � ,
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® New construction ❑ Demolition For specie! information use checklist
Description 1 Total
El Addition/alteration•replacement CI Other: 1- 2-family I .
..- ..,.... _....... � -... ,. _. well (includes dwellings me cs 1
� � or each utility connection)
, :_.- _.,.;:_. 1 _....� ;; ,.. ; �_.:; ._..., ._�- ,,:...,� . .�.,. � - _�._i ,: SFR (1 ) bath 3'3.10
�tSTEG - O Ye OF ,'COlVS1'RLf�'�i<b _�E -- ;T`: :__ -:;
® 1 - and 2-family dwelling ' ❑ Commercial/industrial SFR (2) bath 437.78
1:11 Accessory building SFR (3) bath 500.32 '
❑ Mu - family
Each additional bath/kitchen 2 5.02
Master builder ❑ Other:
=" _ ., -w ii'r 'Fire sprinkler ( sq. ft) 1 Page 2
- :a ' _:: - TOB`SITE-:I
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°`�; 1, �_ '.''�i __ �'�l;F � .._ �R'I�011�i�.�OG1T10AT;i ` ='- -- ;` Site utilities:
CZ C' � T: Cater basin or area drain 18.76
Job site address: -
�SL/ ! .t, L en)r -cwt
City/State /23': T/ .- C � Z q) a �J Dtywell leach line, or trench drain 18.76
o / J Footing drain (no. linear R.; ) Page 2
Suitc/bldgjapt. no.: 1 Pmjea natne:�}y j! ,. 1-6 C is Manufactured home utilities '
`` ,, '' 50.03
Cross streetldirections to job site: Manholes 18.76
6 ee-F / „- 1.61 7 •7 .tLfr)q G ^ c)i I Rain drain connector . 18.76
J �GrL1..s - Sani wry sewer(ra. linear ft.: 1 Page 2
! Storm sewer (eo. linear ft.: `) Page 2
Water service (no. linear ft.: ) I Page 2
Subdivision: A I ! , 17h7) ,.. 1 y! (ms's lot no.@,s Fixture or item:
Tax map/parcel no.: o S i Bacl.-`low preventer x I 31.27 31.27
i'r�'� `iK)m',i i v `:1 DFSCRIPI art ; : > , � ! : .:_ Baclavatervalve 1251
„ys•i.�.,rtii .'s'ii: i. D,VIrpRIC�.i.k?, " Zl�'41,:11: -
±,:.: >.. m..._ .....,, -,.a ,,.:.,.. ,.3 .. .... Clothes washer
Landscape Irrigation Back Flow Device 25.02
. Dishwasher 25.02
Drinking foimtaio 25.C2
• Ejectors/sump 25.02
I �i F' i' ,74:- Z - ig3 PROPiiiil?i. - _ ;:: _ A F C ': ° " - - a ir
t .
:r. „e.:�g - ,E OWiVER � .:r' - • °• , . .., 1. , - ,.. -�- - ;,� 1- ... .:.... ..e. . R � �j Expansion lack 12.51
Nam= Stone Bridge Homes NW LLC Fixtiueisewer cap 25.02
Address: 4230 Gnlewood Street Suite 100 • Floor drain/floor sinkRiub 25.02
Garbage disposal . 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib •
2
25.0_
Phone: ( ) Fax: ( ) Ice maker 12.51
. �r!! , ;` :,-, __. i, ;.i__-1!n --_ yM: OI�IAEI P " s. ._. Ui terc bore ease o
. :, ...__. „- .._ - w ;
' - _1'��C . - _ � �O�� ,, .� eP 8r trap 25.0
Business name: Landscape Oregon, Inc. Medical gas (value: S ) Page 2
Contact name: Ellen Sparrow Printer I 12.51
Roof drain (commercial) 12.51
Address: P.O. Box 2386 Sinkbash ll vvatory 25.02
City/State:ZZIP: Tualatin, OR 97062 Solar mats (potable water) 62.54
Phone: (503) 692 -5945 j Fax: : (503 -) 692 -0768 Tub/shower/shower pan 12.51
E -mail: ellen@landscapeoregon.com Urinal 25.02
'a yi n r= _ 5::" ,s: , _ . . = ):i = i = 7Jatercloset 25.02
t4 ∎,, r 4 .
:_.;. - ;C41 i1t1TOR;;r. _ .ii - -,': l:
x ._!; . i �•: ;I. S,'; W`E= 3'_7.:.,_ •:a: • .,, .,, u..: -.. 1.. �.. ,E;Jr •; ..,:i : c ,.t_ di, 1.i:1 :, water beater •
37.52
.• Business name: Landscape Oregon, Inc.
Water piping/DWV • 56.29
Address: P.O. Box 2386 Other. 25.02
Cit) /State/ZlP: Tualatin, OR 97062 . Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum Permi fee $72,50 72. I
CCB Lie.: LCB 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
State surtbeige (12% of pannit fee) 8.70
Authorized signature: l CL
q/C.l'L,,,-) TOTAL, PERMIT FEE 81.20
Print name: Ellen Sparrow Date ,X'/ )r t This permit epp6mtion e:pltes.[f a permit u not oblalned within 180 days
!!/ F after it has been accepted as complete
-Fee r ethocotogy set by Tri- County Building Industry Servitx Board •
t: U ,PenrisipLMt:•Pe'mic1PP.doc ]am I!09 4443- 4161(1Meo'a•WEB)
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