Permit CITY OF TIGARD PLUMBING PERMIT
. • COMMUNITY DEVELOPMENT Permit #: PLM2009 -00063
T [ G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/24/2009
Parcel: 2S109ACO5300
Jurisdiction:
Site address: 13245 SW NICOLE LN
Subdivision: Lot: 0
Project: WILSON RIDGE NO 2
Project Description: Install residential backflow preventer for irrigation.
Owner: FEES
STONE BRIDGE HOMES NW LLC Quantity Description Date Amount
BY VENTURE PROPERTIES INC, 4230 SW 1 ea Backflow Prevention - RES 03/24/2009 $27.55
GALEWOOD ST #100 1 12% State Surcharge - 03/24/2009 $4.35
PHONE:
Plumbing
9 ea Minimum Fee Adjustment 03/24/2009 $8.70
Contractor: - Plumbing
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 •
PHONE: 503 - 692 -5945
FAX: (503)692 -0768
Type of Use: SF
Class of Work: OTR Type of Const:
Occupancy Grp:
Stories:
Total $40.60
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, spended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility otification Center. .s- les :re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules _
Iss ed By: /� / �� Permittee Signatu 1� �apay��
Call 503.639.4175 by 7:00 a.m. for an inspection that busine*;s day.
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.
lir:- 1
Plumbing Permit Application FiEr a
Building Fixtures %.11,,,t
FOR OFFICE USE ONLY
City of Tigard MAR 2 0 2009 Re 3
Date/By. 01 O AS( Permit N°.: j eliate0E - dilf ) 63
°I 13125 SW Hall Blvd., Tigard, OR 97223
III PIED RevieW
: : • Phone: 503.639.4171 Fax 503.598.196tary OF TIGARD Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIGARD
BUILDING DIVISIONDallotitestattd: rwis: 1 65 See Page 2 for
Internet: www.tigard-or goy
/ Supp/emental Information
-..T:'.. :171 : : - ;:;1:- -::: ;: :'' 7 FEE* SCHEDULE : -:,,_
[21 New construction 0 Demolition ' For special information use checklist.
1 Description I Qty. I Ea. I Total '
D Additionfaiterationintplacernent 0 Other: : New I- 2-family dwellings (includes 100 ft for each utility connection)
.. ... , ,.... . ... „,_ ,„ ,. , ... _ __, , .:-. .., • .._ .__ .
...,' .."- -- CATEGORY:OF: CONSTRUCTION _• SFR (1) bath 249.20
_
N IS, s 1 . - and 2-family dwelling CI Comrnercial/industrial SFR (2) bath 350.00
bath 399.00 b
3) a
0 Accessory building El Multi-family SFR (3)
Each additional bath/kitchen 45.00
• El Master builder 0 Other:
.'„.....;f...' .J013'SiTE .ENFORMAT1ON Page 2
AND LOCATION - : . ' ' -
- , -, ..:,: - • ' ' - Site utilities
Job site address: /321 s4,0 Aii L./.41 c... Catch basin or area drain 16.50
City/State/ZIP: - r/ 944A.4.t 0 R.,.... 9 7 - R-.? il Drywall, leach line, or trench drain 16.60
, Footing drain (no. linear ft: ___) , Page 2
Suite/bIdgJapt. no.: f Project name:al ;i j 07A k e t a .‹._, .2_1
Manutictured home utilities 110.00
Cross street/directions to job site:
; Manholes 16 60
Rain drain connector 16.60
Sanitary sewer (no. lir.ear ft.: _) Page 2
Storm sewer (no. linear ft.: _) I Page 2
Water service (no. linear ft: _) I I Page 2
Subdivision: w try% je_.1..4.,9 C.. Z. i Lot no.: 24
Fixture or item
Tax mapiparcel no.: 65-5 /445,
Absorption valve 16.60
r'
;,i•IJ '.''.,; .+_a:: =.:= ' .;7,:;''llill?felti c ' i '-'il =: i:' .-:'' .- 3!" Backflow prevemer x Page 2 1
Landscape Irrigation Backtlow Device Backwater valve 16.60
Clothes washer i 16.60
Dishwasher 16.60
' -:''-1 i: - ,,. =..;!...", '=. i!, : - ' - - ;'`.,4_ _.,1::: :1; . - , Drinking fotmtain 16.60
.R.: -f; PYt71't':E: ''.:':,..)11 - ::= L- :- . ' ' r '''' '=" - t - ' - ' -. . Ejectore/su 16.60
Name: Stone Bridge Homes LLC
Expansion tank 16.60
Address: 16869 SW 65 Ave 0505 Fixture/sewer cap 16.60
CityiState/ZIP: Lake Oswego, OR 97035 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 1
--.L,--,, 0 ; ,_,: i _._• 1 -, „ ,...:.;, ;,;.:, ......._: -.,. ..--__ -.:-.,.. ., : ..,._,.. 2 Hose bib 16.60
'- :-,:' :',-:-T-_,: -,......, ji ; Alfr,14I,::A.N1 -: 7 ,, , - - .T. .-.. -,-,;---;:`; :- 0 CONTACT TEAsorl„,=.r.
16.60
Business name: Landscape Oregon, Inc
Interceptor/grease trap 16.60
Contact name: Ellen Sparrow Medical gas (value: 5 _ ) Page 2
Address: 12200 SW Myslony Road Primer 16.60
City/State/ZIP: Tua/atin, OR 97062 Roof drain (commercial) 16.60
Phone: (503) 692-5945 I Fax: : (503-) 692-0768 Sink/basin/lavatory 16.60
Tubishower/shower pan 16.60
E-mail: ellen@landscapeoregon.com
Urinal 16.60
-: tON'TRACTOR. : - ; - .. - - 1 :1 : S. " i: - :1 : - :': q Water closet 16.60 •
,
&iciness name: Landscaper Oregon, Inc Water heater - 16.60
Address: 12200 SW Myslony Road Other:
Subtotal
City/State/ZIP: Tualatin, OR 97062
Minimum permit fee: 572.50
36.25
Phone: (503) 692-5945 i Fax: (503-) 692-5945 Residential backflow minimum permit fee: $36.25
CCB Lic.: 7804 ///, / o 7 Plumbing Lie. no.: Plan review (25% of permit fcc)
State surcharge (12% of permit fee) 435
Authorized signature44Zee) ...)
TOTAL PERMIT FEE 40.60
Print name: Ellen Sparrow I Date/20J? 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.
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