Permit CI OF TIGARD PLUMBING PERMIT
' 1 ; V COMMUNITY DEVELOPME Permit# PLM2011 -00320
Date Issued 10/26/2011
T[GAR.D 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S109DA17900
Jurisdiction TIGARD
Site address 15271 SW SUMMERVIEW DR
Project Arlington Heights No 3, lot 108 Subdivision ARLINGTON HEIGHTS NO 3 Lot 108
Project Description Backflow for irrigation
Contractor LANDSCAPE OREGON, INC Owner STONE BRIDGE HOMES
12200 SW MYSLONY RD 16869 SW 65TH AVENUE #505
TUALATIN, OR 97062 LAKE OSWEGO, 97035
PHONE 503- 692 -5945 PHONE 503 - 387 -7577
FAX 503 - 692 -0768
FEES
Quantity Description Date Amount
ea Backflow Preventer 10/26/2011 $31 27
Specifics: 1 12% State Surcharge - 10/26/2011 $8 70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 10/26/2011 $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 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
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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 ApAlica iota
Building Fixtures ritv.i FOR OFFICE'. use ONLY
Receiv
_ City of Tigard r 2 5 201 Da le'B • 1
13125 SW Hall Blvd Ti °ard,OR 979 I �i 7 / • r
Phone 503 718 2439 Fax 503 598 1960
Plan 1P v Other Perms No
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Inspection Line 503 639 4175 CIT/ f r� CIF TIGr'ri'1D Date Ready•By furs RI See Page 2 for
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-' - - -
_- - - FEE * - SCHEDULE
- - �� TYPE OF -WORK -
Z New construction ❑ Demolition For s cia[ in ormanon use checklist
Description Qty Ea Total
❑ Addition/alteration/replacement ❑ Other. 1 New 1- 2- family dwellings (induces 100 ft for cacti utility co'mecnor)
- -- CATEGORY OF CONSTRUCTION SFR (1) bath 312 70
Z 1 -and 2- family dwelling I ❑ CommetciaUmdustnal SFR (2) bath 437 -78
SFR (3) bath 500 32
❑ Accessory building 19 Multi- family Each additional oath/kitchen 25 02
❑ Master builder I 9 Other I Fire sprinkler ( sq. fl) Page 2l -
- - 3013 SITE LNFORMATION AND LOCATION - Site utilities
I
Job site address 15271 Summerview Drive Catch basin or area dram 18 76
Drywell, leach line, or trench Cain 18 76
City/State/ZIP Tigard OR 97224 Footing dim (no linear 0 _) 1 Paget
Suiteibldg /apt no - Project name Arlington Heights Lot 108 Manufactured home ut.lities 5003
Cress streeidischons to job site SVr Summit Ridge Street Manholes 18.76
Ram dam connector 18 76 I
Sanitary sewer (no linear ft.. ) Page 2
Storm sewer (no linear fr ) Page 2
Water service (no linear R _ ) Page2
Subdivision Arlington Heights Lot no.: 108 Future or item:
Tax map /parcel no 655 A6 Backflow presenter 1 31 27 3127 -
DESCRIPTION OF WORK Backwater valve 12 51
Clothes washer 25 02
Landscape irrigation backflow device Dishwasher 25 02
I Dnnk:ng fountain 2502
Ejectors/sump I 25 02
- El _PROPERTY OWNER ❑ TENANT - Expansion tank 12 51
Fixturrlsewer dap ?502
Name Stine Bridge Homes NW LLC
Floor dasrufloor slokhuo I 25 02
Address' 4230 Galewood Street Suite 100 Garage disposal 25 02
GryiState/ZIP Lake Oswego, OR 97035 Hose hib 25 02
Phone. ( ) Fax: ( ) Ice maker _ 12 51
'- Z APPLICANT - Z CONTACT PERSON Interceptor /grease trap 2502
Medical gas (value S _) Page 2
Business name Landscape Oregon, Inc
Pnmer 12 51
Contact name: Ellen Sparrow Roof dram (commercial) 12 51 I
Address 12200 SW Myslony Road Smkbasmgavatory 25 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
E -mail ellca@landscapeoregoo.com
Water closet 25 02
- - CONTRACTOR - - Water heater 37 52
Business name. Landscape Oregon, Inc Water pipmg'DWV 56.29
Address. 12200 SW Myslony Road 1 , Other 2502 I
City:State/ZIP Tualatin, OR 97062 Suhtotal 312
Phone. (503) 692 - 5945 Fax (503) 692 - 0768 Minimum peinut fee 5 50 72 50
CCB Ls • 7804 Plumbing Lic. no.. I Plan rev,ew (25% ofpennit fee)
State soxeharge (12% oC permit fee) A70
,Audronzed signarure.ti ecru, LOLU TOTAL PERMIT FEE 8120
I
This permit application expires it a permit is not obtained within 180 days
Print name' Ellen Sparrow Dale j U �� 1 within after it has bten accepted as complete
1 'Fee methodology set by I n -County Belding industry Seeder Board
I 'Bmldmg eame,PLMU- Pam¢npp doe 100 444t16T(lcoatOM•W'EO)
l d 99LO uelIR B89 50 II 9Z 100