Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 00107
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01/2013
Parcel: 2S109DA14400
Jurisdiction: Tigard
Site address: 15211 SW GREENRIDGE PL
Project: Arlington Heights, Lot 63 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 63
Project Description: (1) backflow device for new SF
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW
PO BOX 2386 16869 SW 85TH AVE #505
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 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. at 8000.332.2344.
Issued By: J ( C , J/ /� / Permittee Signature: 1 /ff / Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
i /
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.
Plambin2 Permit APPIR EIVED
Building Fixtures FOR OFFICE USE ONLY
APR O 1 2013
city of Tigard Received 41 / / 3 �� 1Gl/
Permit No -( / /U
a 13125 SW Ball Blvd., Tigard,
• Phone: 503,718.2439 Fax: TIGARD . Date,By: plan Review
Date Bl I Cater Pcrmi! NOLT /3
T rc nlzn inspection Line. 50 539 ` 33UILDING DIVISIOP�I I Date Ready /B w y J, 0 See Page 2 fur
Internet w ^vw.ttgar[1 or.go . Ivotined,T7cic: I / ( MO I Supplemental lnformadon
- , ? *E,.OF WORK t; _ .EE&." SC'FIEDLf)rE
f ® New ccna action t ] Demolition For special information use checklist � I
Description Qty. . Ea. I Total
� D Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft for each utility counaeon) 1
,j N : r _£ . __ - L4,' EGORy' OF CO�TIRUCTICFi4, ' r '1. SFR (1) bath 1
31�7C
Igi ] and 2- fanuly dwelling ❑ Comm ercral /industrial SFR (2) bath 437.78 1
SFR (3) bath i
C Accessory building ❑ Muin family 1 500.32
Each additional bath/kitchen j,02
❑ Master builder I ❑ Other. Fires Haller ( -
( � a = a -ak �, � ... P � s ft.) I P age 2
�- i r._...1=.= . ;. JOBrSI� 14.4114VC11' 4N]) • VOCATION Site utilities:
Job site address: f S;.? Camh basin or area drain I 18- 6
;! 2r 47,- C t C -V P�Ci C c-
City/State/2W: 7�� �: 24:L c',.#_'. % r 7 ll a L/ Drvwell, leach ]ita oruench J 18.76
Footing dram (no. linear ft-- ' _) I P age 2
Suite/bldg, /apt. no.: I Project name: flrl t e 7 03 Manufactured home utilities
I 50.03
Cross street/directions to job site: Manholes 15.76
(„ j. • nl n 61'1; % f L v De. Rain drain connetor 18.75
Sanitary sewer (no. linear ft: _) , Page 2
Stour. sewer no linear ft.: _) Page 2
Water service (no. linear' ft.: _) { , Page 2
Subdivision: Y1 l n� (Z1 I- ' CG f j4j� I - Lot no.�p 3 Fixture or item:
Tax map/parcel no.: S /l f l Bae1 ow preventer x 3 1.27 31.27
(✓ij.1 „_ f r DRS Off; :ViWORIfi`R s a s Backwater valve 12.51
? ;t Clothes washer 2 n.02
Landscape Irrigation Back Flow Device J
Dishwasher 25.02
Drinking fountain _ 25.02
Ejectors /sump 25.02
11 °l' ll 0Qp3:iE - . i -. _' r r 4. '3Y1 4 r< ^ t " 0 ' 1 �TT1' E.xpanbiOtt tank 12.51 I
Name: Stone Bridge Homes T W LLC j -._� Fistura'sewer cap 2
Address: 4230 Galewood Street Suite 100 Floor drainlfloor si k,bu� 25.02
Garbage disposal . 25.02
City /State/ZIP: Lake Oswego, OR 97035 Hose bib • 25,02
Phone ( ) Fax: ( ) lee maker a
� wa e �
12._ 1
tt
1 . . APPLI:c;ov ' ®CON7'.ACT PER O t x intercept trap 25.2 1
Business name: Landscape Oregon, Inc. Medical gps (value: S Page 2
Contact Hamm Ellen Sparrow me 12.51
Roof drain (commercial) 12.51
Address: P.O. Box 2386
Sink/basin/lavatory 25.02
City/State/71P: Tualatin, OR 97062 Solar units (potable water) I 62.54
Phone: (503) 692 -5945 I Fax:: (593 -) 692 -0768 Tub /sbowerishowerpan I J 12.51
E -mail: ellernlandscapeoregon.com Dank 25.62 J
c` t' „a b 6y ` , ' fiO3t1TR.+ O
CTR � t 5-4. l..', - :".:".' 1 ; . 'n :ii.i4 Water closet 25.02
�. ,: _, .4 ;.11 .11 a a r t kf water 37.52
Business name: Landscape Oregon, Inc. Water ins DWV 56.29 '
Address: P.O. Box 2.386 P =P a
Other: I I 25.02
City /State/ZIP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee: S72.50 72.50 II
CCB Lio.: LCB 7804 Plumbing Lic. no.: Plan review (25% of permit fee)
- � State surcharge (12% of permit fee) , 8.70
Authorized signatur ›.. -" L ` � ,tk_.; i TOTAL PERMIT FEE I 81.20
Print name: Ellen Sparrow Date: 2.4://z.6).3. This permit application explretiif a permit la nut obtained within 1 50 days
3 after It has been accepted as complete.
'Fee nlet1txioiegy set 1/3. Tri Build,it Industry Service Enard
:113t2ildasTetmr:U7[-Permil .max ID,i 440 -if I 6T(iC/C_'COx9WEB)
vd 89LO 69 Ueii3 e91:90 el. 6z sew