Permit CITY OF TIGARD PLUMBING PERMIT
13 COMMUNITY DEVELOPMENT Permit #: PLM2013 00206
T L G AR. D 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 06/26/2013
Parcel: 2S109DA16800
Jurisdiction: Tigard
Site address: 15453 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 97 Subdivision: ARLINGTON HEIGHTS NO 3 Lot: 97
Project Description: Irrigation backflow device for new SF
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
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 06/26/2013 $31.27
Specifics: 1 12% State Surcharge - 06/26/2013 $8 70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 06/26/2013 $41 23
Class of Work: OTR
Plumbing
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 que s to • • C by calling 503 232.1987 or 1.800.332.2344.
Issued B : ( Permittee Signature:
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.
Jun 25 13 11:05a Ellen 503- 692 -0768 p.1
11
Plumbing Permit Applicatit -,. G EN E ®
Building Fixtures JUN 2 5 2013 OR OFFICE USE ONLY
Received
t r City of H alard 7C � y EB a 5A3 (/ Ferran l:c : / 4 �i/o 2 0/ 7 -C22 t 2
a 13135 S J' Hall Blvd , Treard, OR 9 ®�� I IGFifID �� I� /' �^
Plan Review / j 7 /3 /
Pone : :03. ?I8.2z?9 Fa;:: 503. Dare'3p: Other Permit N QQ
inspection Line: 5:3.639.4:75 � �tNG D IUIS1�Ir�
Tr GAF D Interne:: www.tr arc -o 0�' Date Ready /By: �•u 6.... el See Page 2 for
g € Not:fied/Methad: T/ Supplemental Information
s. q ' „ .s° TYPE O
, F , WORk `� I' .I `- _SC •
- - - •'-: .FEE*_ HEDT3LE.'.ti -.. ., - _ - -'
® New constr.icticn I, ❑ Demolition For special information use checklist
Description I ON,. Ea. Total
❑ Addi[ton/alteratio ureFlacement I ❑ Other: New 1 -2 -family dwellings (includes 100 ft for each utility connection) '
__. _ _ ; ': ; .CAT E OF' CON _ _ -. _ ,. : - - SFR (I) bath 1 312.70
® 1 and 2-family dwelling ID Cotnme-cialr'industnal SFR (2) bath 437.7E l
❑ .Accessory building ❑ Multi- family
SFR ` 3) bath 500.32
Each additional bathrkit:hen 25.02
❑ Master builder ❑ Other. Fin sprinkler ( _ sq. ft.) I Page 2
- _.IO SITE':INFORMATION'_ ND =LOCATIOlN; 1 ?' - i ' .- . ' Site utilities:
Catch basua or area dram 18 76 I
lob site address: (5 - 3 Si, E./N.111% 17f'Ul u,,r To_ . Drynvell leach sine, or trench drain 18.76
City/State/ZIP: -r`] f a 1 cL 0 IQ e/ UY : `l 7 7 "
Footing drain (no. linen= f. _) ' Page 2
Suite/bldg. /apt. no.: I Project name: /-i .-7 /) p 'f -) 1 ' 7 Manufactured home utilities 50.03
Cross streetidirections to job site: I ■ Manholes 18.
<L, .e. ./A_[L 1.2-0 Rain drain connector 18.76
- Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear ft _ ) I Page 2
Subdivision: 1 4 ) 1 fit /i J I 'Lot no.: q 7 Fixture or item:
Tax map /oarcl no. 6, S' Backflow preventer x 31.::7 3. 27
= Backwater valve . 12.51
- _ - ::`.DESCRIPTION OF V(' _ - - -- ; i
• - Clothes washer 25.02
Landscape Irrigation Back Flow Device
Dishwasher 25,02
' Drinking fountain 25.02
Ejectors/sump 23.02
€ , ; A _ " ® = -P R'T13 OWNER;; - = ❑. TE_41NT . `„ -,' Expansion tank 12.51
Fixture/sewer cap
Name: Stone Bridge Homes NW LLC 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
- _ El APPL•7CAAT. : = - ,$' r .7 CCO_NT CT PERSON - _ - intereptor /grease trap 25.02
Business name: Landscape Oregon, Inc. Medical as (value: b ) I Page 2
Primer 12.51
Contact name: Ellen Sparrow
Roof drain (commercial) i 12.51
Address: P.O. Box 2386 Sink/basin/lavatory 25.02
City/State/ZIP: Tualatin, OR 97062 Solar units (potable water) I 62.54
Phone: (503) 692 -5945 I Fax' : (503 -) 692 -0768 Tub /shower /shower pan 12.51
E -mail: elleu@landscapeoregon.com Urinal 25 02
.. . ..
�• _ --• =' -- - - -: - - _ _ - = - _ _ - • airs set 2 25.02
Rater heater 37.52
Business name: Landscape Oregon, Inc. Water piping/DWV 56.29
Address: P.O. Box 2386 Other I 2
City'iState /ZIP: Tualatin, OR 97062 Subtotal I 5127
Phone: (503) 692 -5945 � Fax: (503) 692-0768 j !�linttritun permit fee: 572.50 l
72.50
CCB Lic.: LC/3 7504 Plumbing Lie. no.: Plan review (25% of permit feel
- 1 State surcharge (12", /Q of permit fee) 8.70
Authorized sigtatsr n c� ,
e ) 1 TOTAL PERMIT FEE 31'0 1 /
�uL , L !
,.
Print name: Ellen Spa I Date. 6.,./04 � ' his permit application expires if a permit is not obtained within 180 days
P Ul, after it has been accepted as complete.
'Fee mettlodcio ' act by Tn -Cwnty Build rag Industry Service Baare.
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