Permit (46) CITY OF TIGARD PLUMBING PERMIT
11111
COMMUNITY DEVELOPMENT Permit#: PLM2016 00250
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439Date Issued: 05/11/2016
TIGARD Parcel: 2S109DB01702
Jurisdiction: Tigard
Site address: 13140 SW BLACK WALNUT ST
Project: Summit Ridge No.5,Lot 163 Subdivision: SUMMIT RIDGE NO.5 Lot: Multiple
Project Description: Irrigation backflow
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: 503-631-3893 PHONE:
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/11/2016 $31.27
Specifics: 1 12%State Surcharge- 05/11/2016 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 05/11/2016 $41.23
Type of Use: SF 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: {JyO` ,ow Signature: � ,p Q�6'6z-77o,\1
Call 5
03.639.4175 by 7:00 a.m.for the next available inspection date. i
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.
,
RECEIVED
Plumbing Permit Application
Building Fixtures MAY 0 5 2016 1 t)It0 .1.1, 1 I.t (1\i
City of Tigard girrti7 ��,. Received -7.re/b , P�m,it yPiiy.'�!/(-4?62SOu
13125 SW Hall Blvd.,Tigard,O ! GARD Oa Rm
r g Phone: 503.718.2439 Fax Plan Re�irx `off-.9/ 0/6-00ac20
1G DIVISION tate B? Other Permit.' f
t 11,n It 1) Inspection Line: 503.639.41 Dae ReafirBy: r*,q.
Internet: www.tigard-or.gov
to See Page 2 for
).Drilled%Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
a New construction 0 Demolition For special ir1Jommmion use checklist
Description
❑Addition/alteration/replacement 0 Other: Qt`' Ea- I Total
New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
*I 1-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 badvkitchen 25,02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Site utilities:
Job site address: 13/ `t/9 >1 $i k •t- ' / t- Catch basin or area drain 18.76
Dp tell,leach line,or trench drain 18.76
Cit>iState/zlP: Tigard,OR 97223
Footing drain(no,linear ft.:,_) Page 2
Suite/bldg./apt.no.: 1 Project name: Summit Ridge
Manufactured home utilities 50.03
Cross street/directions to job site. Manholes 18.76
Rein drain connector 16.76
Sanitary sever(no,linear ft.:,,_�) Page 2
Storm sewer(no.linear ft.:,_---,) Page 2
( Water service(no.linear ft.: ) Page 2
Subdivision: 1 Lot no.: t j 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
JO PROPERTY OWNER ( 0 TENANT Expansion tank 12.51
Name: DR Horton Inc. Fixture/sewer cap 25.02
Address:4380 SW Macadam Ave Suite 100 Floor drain/flooredipa sink/hub 25.02
City/State/ZIP: Portland,OR 97239 Garbage disposal 25.02
Hose bib 25.02
Phone:(503) 222-4151 Fax:( ) Ice maker 12.51
❑ APPLICANT 4 CONTACT PERSON Interceptor/grease trap 25.02
Business name: DR Horton Inc. Medical gas(value:S ) page 2
Contact name:Emerald Weeks Primer 12.51
Address:4380 SW Macadam Ave Suite 100 Roof drain(commercial) 12.51
Sink/basiMavatory 25.02
City/State/ZIP: Portland,OR 97239 Solar wits(potable water) 62.54 -
Phone:(503 )222-4151 x1107 Fax::( 1 Tub/shower/shov;er pan 12 51
E-mail: esweeks@drhorton.com Urinal 25.02
CONTRACTOR Water closet 23.02
Water heater 37.52
Business nameTrademark Landscapes Inc Water piping/DWV 56.29
Address: PO Box 2410 Other: _ 25.02
City/state/zlPOregon City,OR 97045 Subtotal
Phone:(503) 631-3893 Fax:(6-03) (, .4.-_-_%/73 Minimum permit fee: S72.5o
CCB Lic.: / /4 S3 '' Plumbin:Li•.4..: Plan reo iew(25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: fifi TOTAL PERMIT FEE A', 0
Print name: ����f Date:2016 This permit application espirn if a permit is not obtained within 180 days
after it has been accepted as c'ompkte.
*Fee methodology set by Tri-County Building Industry Service Board.
I-Buildinu PertnrtsPLMU-PertnrtApp.doc 1001 09 44046167(10.Og.CONt•1tEB1
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
13140 SW BLACK WALNUT ST, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00250
Don Sylvester
Back flow Febco model 850 ser#HEO9289 approved with test results
Violation Summary:
Inspector Contractor