Permit (9) CITY OF TIGARD PLUMBING PERMIT
$ COMMUNITY DEVELOPMENT Permit#: PLM2016-00187
Date Issued: 04/12/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 2S109DB01702
Jurisdiction: Tigard
Site address: 13128 SW BLACK WALNUT ST
Project: Summit Ridge No.5,Lot 162 Subdivision: SUMMIT RIDGE NO.5 Lot: Multiple
Project Description: New SF
Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC
PO BOX 2410 4380 SW MACADAM AVE, SUITE 100
OREGON CITY, OR 97006 PORTLAND, OR 97239
PHONE:
PHONE: 503-631-3893
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/07/2016 $31.27
Specifics: 1 12%State Surcharge- 04/07/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/07/2016 $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: �`�r / Permittee Signature:
el/3/7L.
,�N l/3/7Li e 4,/
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 GEINJED : s : I ori it t I4 I i�1 iyI
� ems �, n .te i � � , .� }
City of Tigard EReunsea /
/6 i Pe �o 7
• 13:25 SNA Hall Bhd,11gard OR 97223 6 Da,A", r P J
II • Phone: 503 718 2439 Fax 303 598 :9 6 201 Plan Resters
Date.By: i Other__ Pemnt Xo ����
€'lhnttXr; Inspection Line 503.639.4175r ZAt),...
p Date Rests B
�: •r„°=..., Internet ww-\t ugard•or gong o �‘ �� 1 1u . See rage i for
a-��-�''�/ Q bed>terhod Supptemenmlinform arion
TYPE OF ti°ICI s ` ,n1(:,OW I.° FEET SCHEDULE
(1I New construction Weht'.Srttlan v` For special information use checklist
Description I Qt) I Ea I Total
❑Additiorvalteration,replacement 0 OtherI Sew I-2-family dwellings Iincludes 100 R.for each utility,connection)
CATEGORI OF CONS-TM:MON I SFR(11 bath 312 70`
in l-and 2-famil)dwelling i 0 Commercial/industrial I SFR 12)bath 437 78
building
0 AAccessorySFR(31 bath 500.32
❑Multi-family
Each additions;bath kitchen 25.02
0 Master builder 0 Other
Fire sprinkler i sq.n) Page 2
JOB SITE 1NFORSIATIO5 ,AND LOCA`rION1 a Site utilities:
Job site address: I'32 1 rL. f }^1 Catch basin or area drain i 18 76
Cit)/State Z1P: Tigard,OR 97223 c —' S Dnwell.leach line,or trench drain 1 18.76
k. x 1-t
g Footing drain(no linear ft �) Page
Suite/bldg.lapt no. Project name' Summit Ridge Manufactured home utilities
50 f!3
Cross streetidirecuans to job site Manholes 18.76
Rain drain connector 18.76
Sanitar)sewer(no linear ft 1 Page 2
Storm sewer(no linear ft ) Page 2
Water service(no linear ft. ) Page 2
Subdivision: I Lot no.:VQ Fixture or item:
Tax map/parcel no. Backflow preventer 1 31 27
I- DESCRIPTION OF ii'ORR I Backwatercahe )2 cl
�'E a •'1
1 = i Clothes washer 25 02
/7.O ;„,--1 C'
- 1 ,j✓ v ^--- 1 s Ci .•
Dishwasher 25 02
I Drinking fountain 25.02
Ejectors.'sump 25 02 i
V PROPERTI” O11".1ER 0 TENANT Expansion tank 12.51
Name DR Horton Inc. Fittura'sewer cap 25 02
Addicts Floor dram'floor sink'huh 25 02
4380 SW Macadam Ave Suite 100
Garbage disposal 2;
Cit)/Stale/ZIP Portland,OR 97239 U2
Hose bib
Phone.(503) 222-4151 Fax ( ) 25 02 --••-I
Ice maker 12 51 i
0 APPLICANT CONTACT PERSON Interceptongrease trap 25.02 I
Business tame: DR Horton Inc. Medical gas(value S�) Page
Contact name r Primer 12 51
Emerald V1 eeks 1 Roof drain(commercial) 12
Address-4380 SW Macadam Ave Suite 100 i_01
Sinkkiasirtlavator 4 25,02
Cir'State'ZIP Portland,OR 97239 Solar units(potable water) 62.54
Phone'(503 )222-4151 X1107 I Fax, :i Tub"shosserrshower pan 12 51
I
E-mail esweeks@drhorton.com tnnal X502
CONTRACTOR Water closet 25(n
Pieter heater 37 52 i
Business narneTrademark Landscapes Inc
Water piping DPP'P56.29 IAddress' PO Box 2410 Other' + 25 02 I
cit)Btate/ZIPOregon City, OR 97045 SubtotalHI
Phone:(503) 631-3893 I Fax (663l G3/-y.73 7 I Minimum permit fee 1772.50
CCB Lic.. 3 Plumbing L1e no _ k I Plan rev lei' 12506 of permit fee) I
e,....„.7...
7—' I State surcharge(;2°n of permit fee) 1
Authorized signature. rte,/ +,�,_" ,. I 1
S / I TOTAL PERMIT FEE I$7•� 1
Print name tJ E. 1,(7,:r Date 2016 Thu permit application engines if a permit is not obtained withia 180 days
after it tans been accepted as complete.
"Fee methodolom set hr Tri.r ounn Building indust,Scrvtce Board.
' Bulldog Perxuu PLVL PerreiApr dec 100109 4404^0 cT:It cc CO\t OVF.B;
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
13128 SW BLACK WALNUT ST, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00187
David Young
1" febco model 850, serial # HE09317 located left front yard.
Violation Summary:
Inspector Contractor