Permit (42) CITY OF TIGARD COMMUNITY DEVELOPMENT PLUMBING PERMIT
y Permit#: PLM2016-00132
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2016
TWARD�'* Parcel: 2S 109D B07600
Jurisdiction: Tigard
Site address: 13020 SW KOSTEL LN
Project: Summit Ridge No.5, Lot 144 Subdivision: SUMMIT RIDGE NO.5 Lot: 144
Project Description: Backflow preventer for irrigation
Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC
PO BOX 2410 4380 SW MACADAM AVE SUITE 100
OREGON CITY, OR 97006 PORTLAND, OR 97
PHONE: 503-631-3893 PHONE: 503-222-4151
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/02/2016 $31.27
Specifics: 1 12%State Surcharge- 05/02/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/02/2016 $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: / eermittee Signature: Q • .--�.
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 tCEIVED
City of Tigard ���p Re e:137 1 n U�lZ—
t7r9r772 9 2016 Date By 4 /l� ,� .�/7 Pertntt\o U
q 131_o SW Hall Blvd.,Tigard.O 3
' a Phone: 503.718.2439 Fax; g Plan Review Other Permit No
Inspection Line: 503.639.41
_ O TIGARD Date By
1 I G A R D Date Ready:By Juris• ® See Page 2 for
Internet: www:tigard-or.go4' NG MIS' Notified,rlethod: Supplemental Information
TYPE OF WORK v FEE" SCHEDULE
Nes:construction ❑Demolition For special information use checklist
Description I Qtv. I Ea. 1 Total
❑.Addition/alteratiow'replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
e 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437,78
D Accessorybuildins SFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25 02
❑ Master builder 0 Other: Fire sprinkler(�sq.rt.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: t' (r.-52,,D S-V\.) p tip' Catch basin or area drain 18.76
1�� � 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.: I 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 it:i Page 2
Storm sewer(no linear ft. _t Page 2
Water service(no linear ft. _) Page 2
Subdivision: � Lot 144 Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25 02
New SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25 02
• PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: DR Horton Inc. Fixture/sewer cap 25.02
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 .CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ t Page 2
Business name: DR Horton Inc.
Contact name: Primer 12 51
Emerald Weeks Roof drain(commercial) 12 51
Address:4380 SW Macadam Ave Suite 100 Sinkbasin lavatory 25.02
City/State/ZIP: Portland, OR 97239 Solar units(potable water) 62.54
Phone:(503 )222-4151 x1107 I Fax: :( 1 Tub/shower/shower pan 12.51
E-mail: esweeks@drhorton.com [;rival 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business nameTrademark Landscapes Inc
Water pipm_.D'.1'V 56.29
Address. PO Box 2410 Other: 25.02
city/State/ZlPoregon City, OR 97045 Subtotal
Phone:(503) 631-3893 I Fax:(6-03) (.,3/-y73 7 Minimum permit fee. $7250
CCB Lic.: ' i Plan review (25%ofpermit fee)
�� Plumbing{ip..to.:mel- e)6ad2
//�� i r i State surcharge(12%of permit fee)
Authorized signature: � i��"t�---.J6 ,
TOTAL PERMIT FEE ,._.?7,
Print name: JE irnS i Dale:2016 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry'Service Board.
I BuildingPermns.PL5ti-PerrretApp.doc 1001'09 44C-461oTi i0 C2 CO\i RVEB 1
L
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13020 SW KOSTEL LN, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2016-00132
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " backflow device Febco model 850 ser#HE21113 approved with test report.
Violation Summary:
Inspector Contractor