Permit CITY OF TIGARD PLUMBING PERMIT
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* . COMMUNITY DEVELOPMENT Permit#: PLM2016-00248
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/11/2016
Parcel: 2S109DB01700
Jurisdiction: Tigard
Site address: 13110 SW KOSTEL LN
Project: Summit Ridge No.5,Lot 147 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
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/11/2016 $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: _, Permittee Signature: DN /970/04.,/c.9-7-70.<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 Ann1I44 C I%Ei J)
Building Fixtures ,012 0I t 1t I t ,t111
City of Tigard MAY 0 5 2016 Received
11- N 13125 SW Hall Blvd,Tigard,OR 97223 thtctey. '�� �(o Permit�opL y.2o�rpaa�
Phone: 503 718.2439 Fax Plan Review Fax(51315y. j` `'D pals By: Other Permit WS/at/6-000/4o
1 1 r.n!t 1>.. Inspection Line: 503.639.41!5 l tli' �lVt�RU _ g,2or
A��( pate RudyiB•: 6 Ste
Internet: wv w.tigard-or.gpyg TILDINC DIVISION Notified%Sletbod: Juni Supplements,Information
TYPEOFWORK FEE* SCHEDULE
4 New construction 0 Demolition For special information use checklist
Description I Q' I Ea. I Total
0 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
I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath
500.32[ Accessory building 0 Multi-family
❑Master builderEach additional battAitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION
Slte utilities:
Job site address: ( 5 fl oft,, 4-05.-t-e-1 1.r1
Catch basin or area drain 18.76
Dryssell,leach line,or trench drain 18.76
City/State/ZIP: Tigard,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt no.: j Project name: Summit Ridge� Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18 76
Rain drain connector 18.76
Sanitary setter(no.linear ft.:__,J Page 2
Storm sewer(no.linear ft.:_J Page 2
Water service(no linear ft.:_,J Page 2
Subdivision: I Lot no.:
1 4 7 Fixture or Item: -
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
New SFR Clothes wusher 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
JO PROPERTY OWNER I 0 TENANT Expansion tank 12.51
II
Name: DR Horton Inc. Fixture/setter cap 25.02
Address:4380 SW Macadam Ave Suite 100 Floor drnir✓tloorsink/hub 25.02
Garbage disposal
g25.0
2
city/state/zit). Portland,OR 97239
Hose bib
25.02
Phone:(503) 222-4151 Fac:( ) Ice maker 12.51
0 APPLICANT *CONTACT PERSON lnterceptorIgrease trap 25.02
Business name: DR Horton Inc. Medical Bas(value:S ) Page 2
Contact name:Emerald Weeks Primer 12.51
Roof drain(commercial) 12.51
Address:4380 SW Macadam Ave Suite 100 Sink/basiMavatory
25.02
Ci /State/ZIP:
n Portland,OR 97239 Solar unitsotable utter) -) _ 62.54
Phone:(503 )222-4151 x1107 Fax::( ) Tub/shower/shower pan 12.51
E-mail: esweeks@drhorton.com Urinal 25.02
Water closet
CONTRACTOR 25.02
Water heater 37.52
Business nameTrademark Landscapes Inc Wateri in
PP g/DWv
Addrtss: 56.29
PO Box 2410
Other:
25.02
City/State/ZIPoregon City,OR 97045 subtotal
Phone'(503) 631-3893 Fax:(4563) G3/_ - Minimum permit fee: 572.50
CCB Lie.: 1 f 3 s3 l .Plumbin Li ,no tG` � Plan review(25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:
TOTAL PERMIT FEE I/ Q
Print name: • Tbts persalt application moires if a
5� t_ i /% Dale: DP P permit 1a netpkte.obtained within t80 dans
/7-e �` 'f 2016 after it bas been accepted a1 eooi kte.
P
"Fee methodology set by Tri-County Building Indian).Service Board.
I Buddiny.Pemuu'PL%tU•PennsApp.doc 1001:09 440-4161110'02.CONI WE131
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
13110 SW KOSTEL LN, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00248
Don Sylvester
Back flow device Febco 850 ser#HE09422 located front right of house by meter
approved with test report.
Violation Summary:
Inspector Contractor