Permit CITY OF TIGARD PLUMBING PERMIT
II 2 COMMUNITY DEVELOPMENT Permit#: PLM2013-00378
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2013
Parcel: 2S110CB10000
Jurisdiction: Tigard
Site address: 15376 SW ARLINGTON TER
Project: Arlington Heights No.3,Lot 88 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 88
Project Description: Backflow for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
PO BOX 2386 4230 GALEWOOD ST SUITE 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 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 Applicatio ,;ECEIVED
Building Fixtures hlll( OFF ICI. (l)l, o:. .,
II City of Tigard Received
i n 13125 S W Hall Blvd.,Tigard,OR 97223 0 C T 2 3 2 013 OateBy: lU 'At/ / �iI Permit No.: I 0/1_1:10 7 g.
Phone: 503.718.2439 Fax: 60 Plan Review
laspccdon Line 507.639.4173 Date/Dr Other permit No.: M St- )13-V()l i-7-
1 I(.ARt� CITY OFTIGARD Date amovay: �Page for
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i II\U 111 V 6JI I ' Notified/Method: fJ�� Supplemental Information
TYPE OF W FEE* SCHEDULE
® New construction 0 Demolition For special information use checklist.
0 Addition/alteration/replacement 0 Other: Description I Qty.
Ea. Total
New 1-2-family dwellings(includes 100 ft•_for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
® 1-and 2-family dwelling 0 Commerciajmdustrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Other
additional� � 25.02
•
File sprinkler(__sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:IC,-73 y�(4- S Li_ Catch basin or area dram 18.76
11-),//1yi- -.- 1- , ei <L .
3tywell,leach link or trench drain 18.76 City/StateJE P: 7---]‘,/ti.Le L LL e '7 .; y
Footing drain(no.linear ft.: Paget
-Suite/bldg/apt no.: V I Project name: /Inc/ `'
Manufactured home utilities 50.03
__Cross street/directions-to job site:
Manholes
18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no,Linear ft:_) Page 2
Subdivision: Water service(no.linear ft: ) Page 2
r ll ri'r fe» C.LC,/.L7 5 t Lot no.:E F Fixture or item:
Tax map/parcel no.: 4. ss- 7..-)' / • Bacic7ow preventer x 3127 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Landscape Irrigation Back Flow Device - Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank i 12.51
Name:Stone Bridge Homes NW LLC Fixture/sewer cap 25.02
Address:4230 Galewood Street Suite 100 Floor drain/floor sink/hub 25.02
City/StateJZlP:Lake Oswego,OR 97035 Garbage disposal 25.02
Phone:( ) Hose bib 25.02
Fax:( ) Ice maker
® APPLICANT i 15.0• el CONTACT PERSON Intetzeptor/grease tap 25.02
Business name:Landscape Oregon,Inc. Medical gas(value$ ) l Page 2
Contact name:Ellen Sparrow Primer 12.51
Address:P.O.Box 2386 Roof drain(commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP:Tualatin,OR 97062
Solar units(potable water) 62.54
Phone:(503)692-5945 J Fax: :(503-)692-0768 Tllb/shower/shower pan 12.51
E-mail:ellen@landscapeoregon.com Urinal
25.02
CONTRACTOR Water closet 25.02
Business name:Landscape Oregon,Inc. , Water heater 37.52
Address:P.O.Box 2386 Waterprpwg/DV�y 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 1
CCB Lic.:LCB 7804 Plumbing Lic.no.: Plan review (25%of permit fee)
Authorized signature: _ (/ •• State surcharge(12%of permit fee) : 8.70
j~I •L t'`- TOTAL PERMIT FEEL 8120 ;/
Print name:Ellen Sparrow Dater i_• D, /„i Tbls permit application explres.if a permit is not obtained within 180 days
after it has been accepted as complete.
°Fee methodology set by Tn-County Building Industry Service Board.
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