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Permit n CITY OF TIGARD PLUMBING PERMIT "! COMMUNITY DEVELOPMENT Permit #: PLM2011 -00003 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06/2011 Parcel: 2S109DA17800 Jurisdiction: TIGARD Site address: 15287 SW SUMMERVIEW DR Project: Arlington Heights Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 107 Project Description: Backflow for irrigation. Contractor: LANDSCAPE OREGON, INC. Owner: STONEBRIDGE HOMES NW LLC 12200 SW MYSLONY RD 16869 SW 65TH AVE #505 TUALATIN, OR 97062 LAKE OSWEGO, OR 97035 PHONE: 503 - 692 -5945 PHONE: FAX: 503 - 692 -0768 FEES Quantity Description Date Amount 1 ea Backflow Preventer 01/06/2011 $31.27 Specifics: 1 12% State Surcharge - 01/06/2011 $8.70 Plumbing Type of Use SF 41 ea Minimum Fee Adjustment - 01/06/2011 $41.23 Class of Work: ALT Plumbing 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 OU C by calling 503.232.1987 or 1.800.332.2344. ` � Issued By: V Permittee Signature: { /r 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 1 FOR OFFICE USE ONLY Iii City f Tigard 4� Recoiled 69 I P e rmit No. -l0Oj a I3I SW Hall Blvd., Tigard, O 72 CO Aate�B �� I Plan Review Phone: 503.639,4171 Fax: 503,598.1 23 �P ‘A Datergy. Other Permit No.: Inspection Line: 503.639.4175 �y 0 T 1 G ARTY 7 Date Ready /Bv 02.d. ' El See Page 2 for Internet: www.tigard-or.gov ,n] © \\L\ \otiliedlMethod ( Supplemental 'Worms non - -: TYPE, OF WORK `< FEE' SCHEDULE F or special lnforrnallon use checklist ® New construction ❑ Demolition � Description I Qty. I Ea I Total . ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF COWSTRUCT`fON SFR (1) bath 312.70 ® 1- and 2- family dwel:ing ❑ Commercial/industrial SFR (2) bath 437.78 ❑ Accessory building ❑ Multi - family SFR (3) bath 500.32 Each additional bath kitchen 25.02 Master builder ❑ Other: Fire sprinkler (_ sq. It) Page 2 JOB SITE'- INFORMATION A15ID LOCATION �: Site utilities: Catch basin or area drain 18.76 Job site address; ` g--7 C S 0.... /Y) 1'ylfc v 1 e.t.ti 012 City /State/ZIP: Ti el 6_,.tc.'C, - g___ C; `) ..._L./ L� bill, leach line, or trench drain ] Page 2 / �� ' Footing drain (no. linear ft.:. 1 Paget Suite/bldg!apt. no.: Project mime: 1-9--r I1 vv '1 S Manufactured home utilities 50.03 Cross street/directions to job site: S C LD 'je c , . - &_.mr (t( , .- . Manholes 18.76 0/),110 1_�, 7 rr e . � do , 11 k _- ci /„ Rain drain connector 18.76 - 1 S'•LU S LLry1 ry-11. IJ e 1 Sanitary sewer (no. lines ft.: ) Page 2 t �t ` �� S> Storm sewer (no. linear ft.; ) Page 2 R- t4 1 A -t eWI.db SO.= SLR 111.0 it d 02 --cs7 Water service (no. Iinear ft.: , ) Page 2 Subdivision: j r r! l 1 L ✓<` - Lot no.; r() Fixture or item: Tax map/parcel no.:( 7 S s- Baekftow preventer x I 31.17 31.27 a ate v e ;. -: DF ON OF`WOR.. es washer . r CIoth h 25 02 Landscape Irrigation Backflow Device Dishwasher 25.02 Drinking fountain. 25.02 Ejectors/sump 25.02 ®, PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name; StoaeBridge [James NW LLC Fixture /sewer cap • 25.02 Address: 16869 SW 65 .Ave #505 Floor drain/floor sink/hub 25.02 Garbage disposal osal 25.02 S P City /State /ZIP: Lake Oswego, OR 97035 Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ® A,PPLICAVT ' , � ®CONTACT PECLSON _ Interceptor/grease trap 25.02 Business name: Landscape Oregon, Inc. Medical gas (value: S ) Pace 2 Primer 12.51 Contact name: Ellen Sparrow Roof drain (commercial) 12.51 Address: 12200 SW Myslony Road Sink/basin/lavatory 25.02 City/State/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54 Phone: (503) 692 -5945 I Fax: : (503) 692 -0768 i Tub!shower /shower pan 12.51 E-mail: ellen(a3landscapeoregon.com Urinal 25.02 Water closet 25,02 CO'�TRACTQR Water heater 37.52 Business name: Landscape Oregon, Inc. Water piping/DWV 56.29 Address: 12200 SW Myslony Road Other: 25.02 . City /State/ZIP: Tualatin, OR 97062 Subtotal 31.27 Phone: (503) 692 -5945 , Fax: (503) 692 -0768 Minimum permit fen: 572.50 72.50 CCB Lie.: 7804 i 1/30 / (1 - Plumbing Lie. no.: Plan review (25% of permit fee) l 1 State surcharge (12% of permit fee) 8.70 ! Authorized sigrtature ,r ,L� TOTAL PERMIT FEE 81,20 Pont name: Ellen Sparrow I Date: r s t' • � 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. 1:01u0ding`Per:ni:s P.Mt ?errairApp.doe 10/01,09 447- 4616TO0/02,C0M/wEB) . ltd 99L0 - 909 Uell3 eZ9 :90 14 90 ref