Permit CITY OF TIGARD PLUMBING PERMIT
- tm COMMUNITY DEVELOPMENT Permit #: PLM2011 -00134
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2011
Parcel: 2S109DA14100
Jurisdiction: TIGARD
Site address: 12651 SW MOUNT VISTA CT
Project: Arlington Heights No. 3, Lot 60 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 60
Project Description: Installation of residential backflow preventer for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 16869 SW 65TH AVE #505
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 387 -7577
HONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/27/2011 $31.27
Specifics: 1 12% State Surcharge - 04/27/2011 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 04/27/2011 $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 No • • ion e : 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 OUN r .11in• 503.232.1987 or 1.800.332.2344.
Issue. By: ,\ / * p . % Permittee Sign-4111W r
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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 AuulicatilECE
Building Fixtures APR FOR OFFICE USE ONLY
2 6 Zp» Received Pe radtNo,:
City of Tigard Date/BV: t o !, Ll`h .. ,�
I t 13125 SW Hall Blvd., Tigard, 011t p T plan Review Other PsmitNo,:
1IN l: Phone: 501639.4171 Fax e Datemy:
See Page 2 for
�� `"' ++� -1L/1 ]ups ?I Inspection Line: 50,.639.417 D Date •
T I GARD Internet: wv.�w.tigard-or,gov Notified/Medic supplemental Information
®New construction ❑ Demolition For special it formation use checklist
Description ' Qty. 1 Ea. 1 Total
❑ Addidon/alteration/replaeetneat ❑ Other New 1- 2- family dwellings (includes 100 R for each utility connection)
CJ413 GORY' OF : coNSTRRTld71O1 "' ' SFR (1) bath 312.70
® 1- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02
❑ Ivlaste; builder �,y,� FO ❑ Other: Fire sprinkler (__ sq. ft.) Page 2
, JOBf itieINRMATION t ND LOCATIOIkI - - ° : L site utilities:
Job site address: 12 (e,C f 21A j m o'l t, ' Vl C-0-144r basin or area drawn 18.76
1 G(e O g _ q 7 Lf Footing 1, leach line, or melt drain i&76
City/State/ZIP: / State/ZI _ J Foot' drain (no. linear ti.: _) Page 2
Suite/bldg./apt. no.: I Project name: f -yI j n 91-0-y) (Q ® [~Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18 .76
.ti m a - c j Rain drain connector 18.76
R- A-- ceaj S i" -� -w 01 v (AM vi C- ?-- sanitary Sewer (no, linear ft.: Page 2
Storm sewer (no, linear ft.: ) Page 2
Water service (no. linear ft.: - _J Page 2
-Subdivision: rheI i n3 tifyl Lot no.: •(00 Fixture or item: •
Taxmap/parcel no.: (,r_,. - �}-�,, Backtlow preventer x 31.27 31.27
�.... ! ' t , t -i.. ..it Backwater valve 12.51
Ii0! , Fr :. fi tiO . t71i?WORK. t.1_ ..' .., : I
Clothes wushec 25.02
Landscape Irrigation Backilow Device Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
®P QP _ . ._.. 'TEi4jY ^ r f:1' Expansion tank 12.51
-
, Name: StoneBridge Homes NW LLC • Fixture/sewer cap 25.02
Floor drain/floor sink/hub • 25.02
Address: 16869 SW 65 Ave #505 Garbage disposal 25.02
City /State/ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.5I
IA r t , `eitZ'LICA14 { .... , O 1TA CT •PERSON _ Interceptor /grease trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Ellen Sparrow ,
1251
Roof drain (commercial) 12.51
Address: 12200 SW Myslony Road Sink/basinllavatory 2 5. 02
City / State/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax: : (503) 692 -0768 Tub/shower /shower pan 12.51
Urinal 25.02
Email ellen@landscapeoregoa.com -
1 z water closet 25.02
e t ,,, r -- A 7O>� _ _ . - Water heater 37.52
Business name: Landscape Oregon, Inc, Water piping/DWV 56.29
-
Address; 12200 SW Myslony Road Other: 25.02.
I City / State/ZIP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692-5945 FAX (503) 692 -0768 Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
CCB L1C.: 7604 Plumbing Lie no.: State surcharge (12% of permit fee) S ?
Authorized signature: Iu") TOTAL PERMIT FEE 81.20
Print name: Ellen Sparrow I D at , f - d16 Cii t of This permit application expires if a permit is not obtained within 180 d
l niter it has hose accepted at complete.
"Fee methodology set by Tri -Comity Building macany service Hoard.
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