Permit (12) CITY OF TIGARD PLUMBING PERMIT
IN ■ COMMUNITY DEVELOPMENT Permit#: PLM2016-00503
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/03/2016
Ti i;;�I<.C� g Parcel: 2S109DB01702
Jurisdiction: Tigard
Site address: 13114 SW BLACK WALNUT ST
Project: Summit Ridge No.5,Lot 161 Subdivision: SUMMIT RIDGE NO.5 Lot: Multiple
Project Description: Residential 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 97239
PHONE: 503-631-3893 PHONE:
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/03/2016 $31.27
Specifics: 1 12%State Surcharge- 10/03/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 10/03/2016 $41.23
Plumbing
Class of Work: ALT
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 • • io 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 dire questions to UNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: /l / / Permittee Signat ire: o
•
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.
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IL • 13125 SW Hall Blvd,Tigard.QRt ,� `t t DateB?. j� 3 /�C/� j Pemut\e /�L/��D/�p'00506/e0 ';
= Phone: 303 718.2439 Fax _._. ',3'598-`1%0" 'I - T.A C Plan Review Other Permit No H1T'aoilo_A)O/
Inspection 503.639 4 T D i Date Br.
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Due Ready
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Juni ® �Page 2 for
1 _Supplemental'Information
TYPE OF WORK FEE" SCHEDULE
(a Neta construction 0 Demolition
For special information use checklist
Description 1 Qt, . 1 Ea I Total
0 Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312 70
jilt 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437 78
SFR(3)bath 500.32
❑Accessory building 0 Multi-famih
❑Master builderEach additional bathrkitchen 25 02
0Other: Fire sprinkler(_sq ft 1 Page 2
JOB SiTE INFORMATION AND LOCATION Site utilities:
Job site address r �+1 Catch basin or area drain 18 76
i
Dr-well,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 30 03
Cross street/directions to job site. Manholes 18.76
Rain drain connector 18 76
Sanitary sewer(no linear ft 1 Page 2
Storm setter(no linear ft.:_1 Paget 1
Water service(no linear R. ) Page 2 1
Subdivision: Lot no.: W 1 Fixture or item:
Backflowp
Tax map/parcel no.. rcventer I. 31 27
DESCRIPTION OF WORK Backwater vane 12 51
New SFR
f}, Clothes washer 25 02
Deo/
e/ 'Il L i Dishwasher 2502
t � Drinking fountain 25.02
Ejectors/sump 25 02
$ PROPERTY OWNER 0 TENANT Expansion tank 12 51
Name: DR Horton Inc. Fixture/sewer cap 2102
Floor drain/floor smk,1tub 25,02
Address:4380 SW Macadam Ave Suite 100
City/State/ZIP: Portland,
OR 97239 Garbage disposal 25.02
Hose bib 25.02
Phone.(503) 222-4151 Fax.( ) Ice maker 12 51
0 APPLICANT 4#CONTACT PERSON interceptorigrease trap 2502
Business name. DR Horton Inc. Medical gas(value S—) Page'-
Primer 12 51
Contact name:Emerald Weeks
Roof drain(commercial) 17 51
Address:4380 SW Macadam Ave Suite 100 Sink/basin/lavatory 25 02 1
City/State/ZIP: Portland,OR 97239 Solar units(potable water) 62.54
Phone:(503 )222-4151 x1107 Fax. :( ) Tub/shower/shower pan 12 51
E-mail: esweeks@drhorton.com Urinal 25.02
CONTRACTOR Water closet 25 02
Water heater 37 52
Business nameTradema-k Landscapes Inc Water pipingDWV 56 29
Address: PO Box 2410 Other 25 02
Cir/StatefZiPOregon City,OR 97045 _ subtotal
Phone:1503) 631-3893 Fax'(6'03) (,3/-y737 Minimum permit fee 57250 7a.TO
"
CCB Lic.: j f3 S Plan review 125%of permit fee) —
1PlurnbinState surcharge(12%of permit fee) R.-710// iie.no.:
—
Authorized signature: � .,.,.26/.4,'
TOTAL PERMIT FEE g/.a0
Prim name � � ���/�S Date:2016 This permit application expires if a permit is not obtained within IRU dabs
after it bas been accepted as complete.
'Fee methodology set b.Tri-Count.Building Industrl Senior Board
I Bmldm0 Permns PL Mt-PermnApp dor 10 01 09 4a0-40191(it 0:EOM 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
13114 SW BLACK WALNUT ST, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00503
Don Sylvester
Back flow model Febco 850 ser#HE08953 located front right of house approved with test
report
Violation Summary:
Inspector Contractor