Permit CITY OF TIGARD PLUMBING PERMIT
111 1- 2 COMMUNITY DEVELOPMENT P ermit #: PLM2013 -00251
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013
Parcel: 281 09DA 19000
Jurisdiction: Tigard
Site address: 12641 SW CANYONRIDGE CT
Project: Arlington Heights No.3, Lot 119 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 119
Project Description: Irrigation backflow device.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES INC
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 07/23/2013 $31.27
Specifics: 1 12% State Surcharge - 07/23/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/23/2013 $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.
Issued By: <0 j ' - Permittee Signature: OA) /5 ( f 4 1- 7 - 70A /
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
Building Fixtures
RECEIVEi_ FOR OFFICE USE oNi..Y
City of Tigard
t a 13125 SW Hall Blvd., Tigard, OR 97223 Permit No
Phone: 503.718.2439 Fax: 503.598 1960 J UL 2 2 2013 F lan Review _�� ''��i3 -Da .
TI G A P D
inspection Line 503.639.4/ 75
Dat Re Other Permit N.. ��, / � z �
Internet: www.tigard- or.gov r '�/ /�� 7 ■ e
Date 3eadyiBy:
CI s 1 llf 1 _: Notified./Method:
■ , El See • . . TYPE OF WO' � Supple e u Information
LDING Dt
Page or
l ,.
m o t • ® New construction FEE* SCHEDIILE
❑Demolition For s.ecial information use checklist
1 : 3 Ad dition/alteration/replacement .
CI Other:
escn -non
=MOM
- - New I. 2 -family dwellings (includes 100 ft. for each utility co ectiou) •
CATEGORY; OF CONSTRUCTION ':: SFR(l)bazh
® 1- and 2- fancily dwelling 312.0
❑ Commercial/industrial SFR ( _ 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath _
❑ Master builder Other Each additional bath/kitchen r 25.02 •
:..: ` : dO.. SIT
-E Fire sprinkler r sq. ft.) �
INFORMATION AND.: LOCw4TION i .' iii
Job site address; IIIIIIIII
Catch basin orart a drain
G. Cyr 1 L 1..)- /P t [ (' b� t_T 18.76
City /StateJZ�: � c `L� Drywall, leach line or trench drain linear � �
Suite/bldg./apt. no.: Project name: Ai Footing drain (no. linear ft.: )
Cross street/directions to job site: r i i Manufactured home utilities
' 50.03
_Lc /6 r L t lC( Manholes _ 18.76
R"p —- (,LI11rr i- {L DrZ Rain drain connector _ 11E1E1
• c �' (� ■ 1 0- P 1 f (.(u t t . Sanitary sewer (no. linear ft.: ) _
L [� 1L• C k/L Cl� 7v i t Q t 6. Stor sewer(no.linearft.: )
Page 2
Subdivision: a . I Ae rein j_ - / Water service (no. linear ft.: ) _��
Parcel no.: 1 • . y Lo. no.;/ 9 Fixture or item:
ckflow preventer
Tax map/parcel P
„ DESCIiIPTION:OF WORK ' .. • Backwater valve
x
Landscape Irrigation 27
12.51
p rrigation Back Flow Device Clothes washer 25 02 ME
Dishwasher 25.02 IIIIIIII
Drinking fountain 25.02
Ejectors /sump _ 25.02
® . PROPE32TY'.O S LE R ; ;
T)iNANT Expansion tank �� • Name: Stone Bridge Homes NW LLC Fixture/sewer cap .1.1 Address: 4230 Galewood Street Suite 100 25.02
Floor Garbage disposal sink /hub 25.02
City /State/Z�: Lake Oswego, OR 97035 Hose bib
disposal 25.02
I Phone: ( ) Hose bib In 25.02
, ,. :r,.., :_: Ice maker �
® „A QLTCA11iT. ®C ON TACT PERSON Interceptor /grease cap
Business name: Landscape Oregon, Inc.
MI
Medical gas (value: $ ) Page 2
,
Contact name: Ellen Sparrow Primer _��
Address: P.O. Box 2386 Roof drain (commercial) ®�
City/State /z 'Tualatin, OR 97062 So u sin /lavatory 25.02
Phone: (503) 692-5945 Solar units (potable water) _ 62.54
Fax: : (503 -) 692 -0768 Tub/shower/sho wer pan 25.02
E-mail; ellen@landscapeoregon.com Urinal
Wataclosa MI 25.02 Man
Business name: Landscape Oregon, Inc, Water heater
Address: P.O. Box 2386 Waterpiping/DWI/ _� �
City /State /ZIP: Tualatin, OR 97062 O �� 25.02 11111111
MEal
P one: (503) 692 -5943 Subtotal
Fax: (503) 692 -0768 Minimum permit fee: 572,50 7250
CCB Lic.: LCB 7804 Plumbing Lic. no.: Plan review (25% of
Authorized signature: permit fee)
fir) . w1� Z � State surcharge (12% of permit fee) 8.70
Print name: Ellen Spas-row 1 �� TOTAL PFRMIT FEE 81.20 t/
Date: This permit application expires a permit is not obtained within 180 days
'Fee methodology s B d set by Tri- complete
County
nsuildiea,Permas\PI.M .PermitApp eoe 10 le
B Indusstry try
Service Board.
440.46 16 rp 0'9] /CUM W EB 1
I, a 89LOZ69£0S .oul uo6a.lo edeospue- NV61•:LO £ 1.0Z ?? lnf