Permit IL CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT
Permit#: PLM2016-00157
Date Issued: 04/12/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 12/201 8600
Jurisdiction: Tigard
Site address: 13087 SW BLACK WALNUT ST
Project: Summit Ridge No.5,Lot 154 Subdivision: SUMMIT RIDGE NO.5 Lot: 154
Project Description: Irrigation backflow for new SF
Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC
PO BOX 2410 4380 SW MACADAM AVE
OREGON CITY, OR 97006 PORTLAND, OR 97239
PHONE: 503-631-3893 PHONE:
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/06/2016 $31.27
Specifics: 1 12%State Surcharge- 04/06/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/06/2016 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
h Tigard Municipal Code, State of OR. Specialty Codes and all other
This permit is issued subject to the regulations contained in the pP tY
T s 9 9
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: A /77°/°4-leg-770,1
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
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City of Tigard 2 3 2016 li=ves Permit
Ill . MAR Plat Review y�i� -fla�5'
13125 SW Hall Blvd.,Tigard,OR 97223 7
Plan Review
Phone: 503.718.2439 Fax: 503.59 r
Inspection Lire: 503.639.4175 �1 (OF MARL) DataBy: ��Permit QQ���
I IC,NI:I'
Internet: tiuw.tigard or.go Di 4ISION Date ReadyFBy kris: HI See Page 2 for
BUILDING Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
(e New construction 0 Demolition
For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
f i-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: \ g -fr 4‘..N s- /A i/...00A yv Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Summit Ridge 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
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.:Ic1-1 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New SFR Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
• PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
DR Horton Inc.
Floor drain/floor sink/hub 25.02
Address:4380 SW Macadam Ave Suite 100
Garbage disposal 25.02
City/State/ZIP: Portland,OR 97239 Hose bib 25.02
Phone:(503) 222-4151 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: DR Horton Inc.
Primer 12.51
Contact name:Emerald Weeks
Roof drain(commercial) 12.51
Address:4380 SW Macadam Ave Suite 100 Sink/basin/lavatory 25.02
City/State/ZIP: Portland,OR 97239 Solar units(potable water) 62.54
Phone:(503 )222-4151 x1107 Fac::( ) Tub/shower/shower pan 12.51 +
E-mail: esweeks@drhorton.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business nameTrademark Landscapes Inc
F Water piping/DWV 56.29
Address: p0 Box 2410 Other: 25.02
city/State/ZiPOregon City, OR 97045 Subtotal
Phone:(503) 631-3893 Fax:( ) 6,3/-VT3 7 Minimum permit fee: $72.50
CCB Lic.: 3 s3 - 4,-79(a' P moreltsoZGl3 Plan review (25%of permit feel
�P�ium ' Li no.:
7/� •"�- State surcharge(12°!0 of permit fee)
Authorized signature: v/ TOTAL PERMIT FEE
Print name: L572.�E. i/lis Date:2016 This permit application expires If a permit Is not obtained within 150 days
after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
1 Building Permns,PLMU-PertnrtApp.doc 1001.09 410-3616T(1002:CO. WEB>
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13087 SW BLACK WALNUT ST, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
October 12, 2016 at 10:36:22
AM
PLM2016-00157
Don Sylvester
Back flow Febco model 850 ser#HE07834 approved with test results
Violation Summary:
Inspector Contractor