Permit Er CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
. - Parcel: 2S109DA17600
Jurisdiction: Tigard
Site address: 15319 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 105 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 105
Project Description: Irrigation backflow for new SF
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
12200 SW MYSLONY RD 15319 SW SUMMERVIEW DR
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -5945
PHONE: 503 - 387 - 7577
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/26/2012 $31.27
Specifics: 1 12% State Surcharge - 04/26/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 04/26/2012 $41.23
Class of Work: OTR 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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: " Permittee Signature: Q
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 Applicatinc
Building Fixtures FOR OFFICE USE ONLY
City of Tigard -
0-1 Received
D Y/2. S//2-- ,(6 .90,p3
9
, r 13125 SW Hall Blvd., Tigard, OR 97223 R 2 4 2012 Men Review I
1 . . . Phone: 503.639.4171 Fax: 503(51k4•06q, Dm/3y: t OtherPemut Not/57:Re7/2 ..-jaroiS"
" tior. Line: 503.639.4175 s'''' TivF TIGARD
TIGARD Internet www.tigard-or.gov BUILDING DIVISI . \ ; 3121ca2.Reeac4etti7B7.cd: ' Aviv / .„,111 See nee 2 fcr
t Suppkmental Information
' : :f ' !::.•. l'g VI :N. ]r.,i .:•••••,,I.-ff::1:: '.!.,i,-::, -,::,,!:...,::-=
0 New construction 0 Denstiition Far special information use checklist
Description I Qty. 1 Ea I Total
• 0 Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 f for each utility connection)
. t-2a,ituogii iii, ,...,!,,:;:. ..-....-:: .-,=4 SFR (I) bath 1 312.70
i i:: : - - ..---- , -..J -r.- - . -, , ■.u: ...: ■,,...:. - ;•%i ;!' ' :i'''
FE 1- and 2-fsmily dwelling 0 Commercial/industrial SFR (2) bath I 437.78
SFR (3) bath 500.32
• El Accessory building 171 Multi-family
Each acidnional bath/kitchen 25.02
0 Master builder 13 Other: Fire sprinkl:r (_____ sq. ft) • Page 2
t.: .r ,Z t JOB gitijit4iiiiiikritii_OAStlilzekliti:: Site utilities: • -
Job site address: 1 5 3 19 s IA Inn-le-r\r I etk) D k basin in- area drain 18.76
Drywell. leach line, or trench drain 18.76
City/StateIZIP; T I ci a,-tc.L. OR --) -0_14 Footing drain (no. linear ft.: .....J Page 2
SuitelbldgJapt. no.: J I Project name: A i 1 nq 'h n ,-- ) 10s- Manufactmed borne utilities 50.03
Cross street/directions to job site: Manholes 18.76
- ' Ram dram cannector 18.76
g ce- 2) -bAcL. 12.b --:--) .SLILt-n.rvi 6- u t eu)
' Sanitary sewer (no. linear -I: ____1 Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. lin=r ft.: ___; . Page 2
Subdivision: AT ineff j-k..(..0/K4S Lot no.40S Fixture or item:
Tax mapiparcel no.: ( A ,, _.i- Bicialow preventcr x 31.27 31.27
0 55
12 Backater valve
•,,..,::;A.:1.•:.5...;g:'..:A: ,- .-•••-=;:i:.t ...,:-:•;',• . :, ....... i .....• . '' : : ::_.;::;;;. L 2!1;.: :;:iV ; ,'
. ' Clothes washer 25.02
Landscape Irrigation Bacidlow Device Dishwasher 25.02
Drinking *minim 25.02
- ' Ejecthrs/sump 25.02
' ''••• rigFPROPERTY OWNER :,--:' ' , ''" 'I i ' ",' ".' :TENANT • ' ;:-...i Expansion tank 1/51
i:.....r.,.._ ,.......: :...:,:' - , tt =.:t. !,--°::....: ,....--; -: tilt !f3...-'
Fixture/sewer cap 25.02
Name: StoneBridge Homes NW LLC
Floor drain/floor sinkthub I 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 12.51
gt,t1t--•-iig -ii;j4k ..; te.iiiir- Interceptorlgrease nap 25.02
Medical gas (value: 3 ) Page 2
Business name: Landscape Oregon. Inc.
-Primer 12.51
Contact name: Ellen Sparrow .. drain (commercial) 1151
Address: 1220D SW Myslony Road Sink/basin/lavatory 25.02
City/State/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
_
Phone: (503) 692-5945 Fax: : (503) 692-076s Tubishowenthower pan 12.51
L:rinal 25.02
E-mail: ellen(glandscapeoregon.com 25.02
::. :;: :',-.1" : : f ;1;;3:-:::;;N: .•,-.. ,: :,•_::..,.,:.;!. :.•:;:::
; . ] ;,.. i.m7 - 3 - s .:ii :: 1 .
. 7: :f .:, Water closet
iii,-.,„ 4 Ail-3:2,10.1 ::,.i ,, : !!ii ,..-:1,..r.,1e L:Flt. • Water heater 37.52
Business name: Landscape Oregon, Inc. Water piping/DWV 56.29
Address: 12200 SW Myslony Road Other 25.02
City/Stale/ZIP: Tualatin, OR 97062 Subtotal 21.27
Minimum permit fee: $72.50 72.50
hone: (503) 692-5945
CO3
V Fax: (503)692-0768
Lie.: 7804
i Plumbing Lie. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee)
8.70
.
Authorized signature _ .. 4 „: „ L jtwarci TOTAL PERMIT FEE 81.20
I Dine::1 __ . _ az, . This permit applies if a it . ob p n ic i t n e ed within 160 days
[ Print name: Ellen Sparrow
'Fee methodology set by Tri-Conory Building Industry Servicr, Board.
,......a......m.....:■Airt sni.s 10101g6 440
I, ' d 89La-Z69-£09 • uell3 d:170 Z 1. 17Z idV