Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 00108
T f Ci A.R.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01 /2013
Parcel: 2S109DA13800
Jurisdiction: Tigard
Site address: 15188 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 57 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 57
Project Description: (1) backflow device for new SF
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
PO BOX 2386 4230 GALEWOOD ST #100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 692 -5945 PHONE:
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/01/2013 $31.27
Specifics: 1 12% State Surcharge - 04/01/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 04/01/2013 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /1 �_�
Issued By: J4 r Permittee Signature: C .fV /, . 1 U��T/ !04
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit .kppiicadoREcEi M '
Building Fixtures }oR OFFICE LW. ONLY
City of Tigard APR 0 DatBy: 0 .
Y b . ^� 1 2013 Ree
: ive t i f I ? SI Permi No as 13 -
:3 12 5 STv' Hall Blvd.. Tigard, OR 97"__; plan Review
Phone; 553- 7:82439 Fax: 503 598. Other P l� p.igST j - t,
�IIIOF TIGARD Dot °$`':
enmit
TIGARI? 7nsptton 503 539.4-175
Dateheadyb Y'
t See em Paenral pe i fIn'oor
BUILDING DIVISION NotifiedRrietAcd: I T� B
Int �vww.ti end or. ti
@
T �
3 E OF - PVOB ' -. 1 . : FEE* SCE ---- . _.
® New coast uctian 1 ❑ Demolition For special information use checklist
I Description I Qty. I Ea. I Total
❑ Addition /alteration replace- ent 1 ❑ Other New 1- 2- family dwellings (Mcludes 190 It. for each utility connection;
t'�°� ' €' c EE RS OF CONSTRUCLlo'�1 : „ SFR (1) bath i 312.70 I 1 +
® 1- and 2- family dwelIintr I ❑ Cornmerc.al /industrial SFR ;2) bath 437.78
Accessory building
O • SFR (3) bath 500.32
❑ Mul :i- family -- -
El Master builder I Eacb additional bath/kischen 25,02
❑ Other
I11,94.1.: = Fire sprinkler q ) I - a JOB. SITE . iN i folzkAg7ON .AN,D L66idi - ONi Site utilities:
_ s � Page 2
ss: Catch basin or area drain 18.76
Job site addre
X5 8 Sr�m�FrL'1 w. OR .
fC'
City/State/ZIP: , p Dry well, leach line, or trench drain 18.76
7 Ca -- pR ! �7 L = , ! / - Footing drain _
(no. linear ft.: ) Page 2
Suitdbldg. ?ant no.; Project name: /4Y1 i n.GI ) s 7 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 I
S e..1 ? �L ? rruz.,/.2) 1_)2 Rain drain connector 18.76
Sanitary sewer (no. linear fr.: _) Page 2 , 1
Storm sewer (no. I:near ft.: __,_) Page 2
. Water service (no. linear ft : _) I Page 2
Subdivision/47'i t rtCj h..-7r) Het.s7 e∎- Lot no.: 5 '7 Fixture or item:
Tax map/parcel no (,0 �5 19 Bac1d)ow preventer 31.27 31.27
i :' r DE`N j �. a; y.:' I �. Backxater valve 12.51
Clothes washer 25.02
Landscape Irrigation Back Flow Device
Dishwasher _ 25.02
Drinking fountain 25.02
Ejectorsv'sump 25.02
1 R ;q ®YROPER`Iii.i5 F\'L+ib 14 ;� TEi4,0 ' Expansion tank
Name: Stone Bridge Homes NW LLC
i e4 Fixture/sewer cap I 12.51 25.02 I
Address: 423(1 Galewood Street Suite 100 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
CitylState /ZlP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) I Fax: ( ) Ice makcr
12.51
E' _ .P IC IIV� ®COAT.r7` . PERSON ' , Interceptodg se trap 25.02
• Business name: Landscape Oregon, lac Medical gas (value: $ _ ) Page 2
Contact name: Ellen Sparrow
- Primer 12.51
Roof drain (commercial) 12.51
Address: P.O. Box 2356
Siridcasin/lavatory 25.02
City.'Statc'ZI?: Tualatin, OR 97062 Solar units (potable water) 62.54 j
Phone: (503) 692 -5945 Fax:: (503 -) 692 -0768 Tub /showet/showerpan 12.51 1
E -mail: ellen@landscapeoregon.com 'Uri l 25.02
•
g' 7 ; i i ° !; 1. .; ..�. �i . , b GQ�1TRACTOR k r � . t ; h . r ; 1 _.. , s ` __ ._ _ i Rater closet 25.02
1 37 R'rter beater
.52 ,
Business name: Landscape Oregon, I nc. Water pipingI}l4V ' I 56.2; '
Address: P.O. Box 2386 Other. I I 25.02
City/State/ZIP: T aalatiu, OR 9 7062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692-0768 i Minimum permit fee: 572.50 72.50 i
CCB Lic.: LCB 7804 Plumbing Lic. no.:
Plan review (25% of permit fee) I 1
Authori2ed signature: - i e...,- s )
State surcharge TOTAL PERMIT fee) 8 20
/ I TOTAL PERMIT FEE 81.25
Print name: Ellen Sparrow paid /2A I 16 i.3 I This permit application ecplresif a permit is not obtained - within 110 days
� ! niter k has been accepted a complete
'Fee methodoic • set by Tri -County Building Indusry Sen•i= Board.
1:\ Bsildies , Peraits\PLMI:- ?ermsApo.dcc 1 1:09 4r0a615TiIa7'COo•WEB'J
£'d 89LO Z69 - £09 uell3 8 617:50 Cl. 6Z JeW
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15188 SW SUMMERVIEW DR, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
05/13/2013 00:00
PLM2013-00108
PASS - No C of O
1" wilkins mod 350 serial number A134780
Violation Summary:
Inspector Contractor