Permit CITY OF TIGARD PLUMBING PERMIT
11114
s , COMMUNITY DEVELOPMENT Permit#: PLM2013-00338
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/26/2013
Parcel: 2S109DA17100
Jurisdiction: Tigard
Site address: 12669 SW WILLOW POINT LN
Project: Arlington Heights No.3,Lot 100 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 100
Project Description: Backflow for irrigation.
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: 503-387-7577
HONE: 503-692-5945
FAX: 503-692-0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/26/2013 $31.27
Specifics: 1 12%State Surcharge- 09/26/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 09/26/2013 $41.23
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
II
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: 11111■ 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.
Plumbing Permit Applif„. ,,,, IV
Building Fixtures ,. Ll • FOR OFFICE- USE ONLY
City of Tigard SAP 2 5 2013 te>B� 9� Peruit No.: 1
. a 13125 SW Hall Blvd.,Tigard,OR 23 v r� �-
Plan Review
Phone: 503.718.2439 Fax: 5 DBteB r Other Permit No.:M ST�)/?-t�IP
T 1 c,A�`n Inspection Line; 503.639.41751 l TIGARDp Date Rea /B Tuns: ® See Page 2 for
Internet: www.tigard-or.gov '1 Ir mil sInN Notified/Methood: g
�L�1�1�1�,� %�� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
I New construction ❑Demolition For special information use checklist.
Description _Qty. Ea. j Total
E]Addition/alteration/replacement C Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRIICTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
❑Master builder Each additional'oathMldtchen 25.02
❑Other.
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: i'. L.(i'I [.t i /I C,..`L, j)G (i 1 f' LL/1 Catch basin or area drain 18.76
City/State/ZIP: Drywell,leach line,or trench drain 18.75
7'(ci`L"Lt( � c C f 7 rr� Footing drain(no.linear ft.: 1 Page 2
Suite/bldg./apt.no.: Project name: /y/' c .. .-y) 1( ?.' Manufactured home utilities 50.03
-Cross street/directions to job site: Manholes 18.76
Rain drain connector 18 76 c L Li-11 01 f i''\, i si L L 7/'t e■
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision://,- y- -y1 1---1- 4.el Lot nc./ >1' _
U Fixture or Item:
Tax map/parcel no.: 55 ,,..q- Backflow preventer x 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Landscape Irrigation Back now Device
Dishwasher 25.02
__ Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 0 TENANT Expansion tank 1231
Name:Stone Bridge Homes NW LLC Fixture/sewer cap 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
® APPLICANT El CONTACT PERSON Interceptor/grease trap 25.02
Business name:Landscape Oregon,Inc. Medical gas(value:S ) Page 2
Contact name:Ellen Sparrow Printer 12.51
- Roof drain(commercial) 12.51
Address:P.O.Box 2386 Sink/basin/lavatory 25.02
City/State/ZIP:Tualatin,OR 97062 Solar tines(potable water) I 62.54
Phone:(503)692-5945 Fax::(503-)692-0768 Tub/shower/shower pan 12.51
E-mail:ellen@landscapeoregon.com Urinal 25.02
Water closet 25.02
CONTRACTOR Water heater 37.52
1 Business name:Landscape Oregon,Inc.
Water piping/DWV 56.29
Address:P.O.Box 2386 Other 25.02 _
City/State/ZIP:Tualatin,OR 97062 Subtotal 31.27
Phone:(503)692.5945 Fax:(503)692-0768 Minimum permit fee: 572.50 72.50
Plan review (25%of permit fee)
CCB Lic.:LCB 7804 ‘,./.-.- Plumbing Lie.no.:
State surcharge(l2%of permit fee) 8.70 /
Authorized signatur � Z c.
� . L.1, EE ✓
e-LC- TOTAL PERMIT F 81.20
Print name:Ellen Sparrow Da[� / This permit application exptres.lf a permit l not obtained within 180 days
1/ Xt` after it has been accepted m complete
*Fee methodology set by Tri-County Building Industry Service Board.
1;:Builtlty,.PersIts,PLMU.PomnApp.doe tC'C109 440-1616T(10.0_COM WEB)
L abed 89LOZ69£05 .x11 uo6a.lo adepspuei Wdt70:£0 £LOZ 5Z daS
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
12669 SW WILLOW POINT LN, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
2013-10-29 00:00:00
PLM2013-00338
PASS - No C of O
1" wilkins model 350 serial no. A301907
Violation Summary:
Inspector Contractor