Permit CITY OF TIGARD PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit#: PLM2013-00376
TEGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2013
Parcel: 2S109DA13600
Jurisdiction: Tigard
Site address: 15154 SW SUMMERVIEW DR
Project: Arlington Heights,Lot 55 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 55
Project Description: Backflow for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: COLUMBIA STATE BANK
PO BOX 2386 BY JECK,AL
TUALATIN, OR 97062 17800 SE MILL PLAIN BLVD, STE 10
VANCOUVER,WA 98683
PHONE: 503-692-5945 PHONE:
FAX: 503-692-0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/28/2013 $31.27
Specifics: 1 12%State Surcharge- 10/28/2013 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment- 10/28/2013 $41.23
Plumbing
Class of Work: ALT
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: • 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 Application
Building Fixtures RECEIVED lilt p-
MFIC I. UtiL ONLY
N., City of Tigard Received
v I3 L25 SW Hall Blvd.,Tigard,OR 97223 DetrnBy; 10lif/3 617--- Permit No.: 1.O r c)' -�0.r)2i
i Phone: 503.718 2439 Fax: 503.598.1 T 2 Plan Review' I� l J �' J G
Ins cctien Line: 503.539.4176 3 2 013 Other Permit No.:
T u"iAki. p _ /�►S�dor�-va 1.37
Internet www.tigard-or.gov Diu Ready/[iy J�ru Q1. See Page 2 6or
Notiffed/Method: 1,.:-.:6) Su lemental ioformadoa
TYPE OF WOCITTMFTIUMID
[fig g��LEI FEE* SCHEDULE
®New construction 13 HIA46DIVISION For special information use checklist
❑Addition/alteration/replacement 0 Other: Description [ Qty. 1 Ea. L Total
New 1-2-family dwellings(includes 100 tt for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® I-and 2-family dwelling ❑ Commercial/industrial SFR(2)bath 437.78 l
❑Accessory building ❑Multi-fly SFR(3)bath 500.32
-
❑ Master builder Each additional bath/kitchen 25.02
• ❑Other:
'Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCAITO e
Stte utilities:
Job site address: (55;S f j `(l)1111. r'1, i 6 e Catch basin or area drain 18.76
City/State/Z1P: Ti c� t,L,� I'2 cr, 7 3 1/
Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.: Footing drain(no.linear ft.:_ ) Pape 2
' Project name:/H'/i viy 7Z.), 5S
Cross street/directions to job site: J Manholesrrrtd home utilities 50,03
Manholes 18.76
Rain drain connector 18 76
Sanitary sewer(no.linear ft_: _ Page 2
Storm sewer(no.linear R.: ) Page 2
Subdivision: Water service(no.linear ft.:
/ r r,oz,z 1. c
‘//1"-?'S ' Lot no.: .1s- Fixture or item: _� Page 2
Tax map/parcel no.: (-s-S /`� Backflow preventer x 31.27 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Landscape Irrigation Back Flow Device Clothes washer 25.32
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER , ❑ TEST Expansion tank 12.51
Name:Stone Bridge Homes NW LLC - Fixturelsewercap 25.02
Address:4230 Galewood Street Suite 100 Floor draialfloorsink/htrb 25.02
Ga
City/State/ZlP:Lake Oswego,OR 97035 rbage disposal 25.02
Phone:( ) Hose bib 25_02
Fax:( ) Ice maker
ID
APPLICANT C.4 12.51
=.4 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Landscape Oregon,Inc. Medical gas(value:$ ) page 2
Contact name:Ellen Sparrow Primer 12.51.
Address:P.O.Box 2386 Roof drain(commercial) 12.51
S'
City/StateDP:'Tualatin,OR 97062 �in/lavatory 25 02
Solar units(potable water) '
Phone:(503)692-5945 f Fax:: 12.51
2.5
(503-)692-0768 Tub/shower/showerpen
E-mail:eilen®landscapeoregon.com Urinal 15.02
CONTRACTOR Water closet 25.02
Business name:Landscape Oregon,Inc. Water heater 37.52
Address:P.O.Box 2386 Water pipinglDWY 56.29
Other 25.02
City/State/ZIP:Tualatin,OR 97062
Subtotal ' 31.27
Phone:(503)692-5945 Fax:(503)692-0768 . Minimum
permit fee: $72.50 72.50
CCB Lic.:LCB 7804 Plumbing Lic.no.: Plan review(25%of permit fee)
Authorized signature;, g i , • State surcharge(12%of permit fee) 8.70
fti_ C L't C'Z L% TOTAL PERMIT FEE 81.20 ✓/
Print name:Ellen Sparrow I Date: 6.j; 3 / . t I; T b permit application expires.if a permit is not obtained within 180 days
i / ! , after It bas been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
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