Permit IN � � CITY OF TIGARD PLUMBING PERMIT
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= COMMUNITY DEVELOPMENT Permit #: PLM2012 -00094
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2012
, Parcel: 2S109DA15100
Jurisdiction: Tigard
Site address: 15374 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 70 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 70
Project Description: Irrigation backflow for new SF
Contractor: LANDSCAPE OREGON, INC. Owner: COLUMBIA STATE BANK
12200 SW MYSLONY RD BY JECK, AL
TUALATIN, OR 97062 17800 SE MILL PLAIN BLVD, STE 10
VANCOUVER, WA 98683
PHONE: 503 - 692 -5945 PHONE:
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
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Perrnittee Signature:
l?ic/ �/ /cO/1
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project
Approved plans are required on the Job site at the time of each inspection.
Plumbing Permit Application RECEIVED
Building Fixtures FOR OFFICE USE ONLY
APR 2 4 2012 Received
11 I, City of Tigard Date/By: / ZS L 4 • it No.�L _ - 0 9 r
4 13125 SW Hall Blvd., Tige_ d, OR NX OF TIGARD Plan Review Other Permit so
Phone: 503. 639.41',1 Fax: 503.5 Datelly: %JST�p //-0Q/
T LGARD Inspection Line: 503.639.4175 DING DIVISION mete xeady/By: �� ®See Page 2 far
Internet www.tigard VetifiedML^thod I Sapplementa1 information
.; TYPE OF WORK -
- - ,. . __ : 1TE• SCT:iEAULE
® New consInIction ❑ Demolitior. For speciie!informuion use checklist
- Description I Qty. I Ea. Total
❑ Addition/alteration/replacement - ❑ Other. New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF ONSTRIlCTION _ SFR (1) bath 312.70
I$ 1- and 2- family dwelling ❑ Commercial/ industrial ial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family
SFR (3) bath 500.32
[] Master builder Other. Each additional bath/ldtchen 25.02
LT sprinkler (_ sq. ft) ' Page 2
JOB SITE A ND 'LOCATION Site utilities:
Job site address: j53 r L : -/ _9 0 .L�.m mcr! J/ ' Die- Catch basin or area drain 18.76
G .(Z- ��� Drywell, leach line, or trench drain 18.76
City /State/ZIP: - 7 - I / l a. tic
Footing drain (no. linear ft.: _) Page 2
Suitefoldg. /apt. no.: I Project name: (-t 1 f l /Z � -f'CY - 7 L•
Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S 13 c -1 B e-f\ . :k-_ .() C_CL Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ..___) Page 2
Storm sewer (no. linear ft.: _I Page 2 !
�/ t! t � /J • Water service (no. linear fl.: ) Page 2
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Subdivision: '� , j'lC' ft-y) Hr.-9 1 jt I Lot no.: 1 7 G' Fixture or item:
map/parcel map /pael no.: L 5 A . d 7 J Backflow preventer i x 31.27 31.27
- Backwater valve DE5CRIP - :OF WORK . . a; :
Laodscape Irrigation Backflow Device
Clothes washy 25.02
Dishwasher 25.02
Drinking foi:ntain 25.02
Ejectors/sump 25.02 I
a :.
.. :_ .,`- :® ; ;PROPERTY.`OW?IER _4 : I __..:. _-. 0 TENAiNllt! •_ ^ I Expansion tank 12.51
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Name: StoneBridge Homes NW LLC i 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 12.51
® APPLIC4NT ® CO \T.ACr PE RSON - Interceptor/grease trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: S _ ) Page 2
Contact name: Ellen Sparrow
Primer 12.51
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 J Fax: : (503) 6924768 Tub /shower /shower pan 12.51
E -mail: ellen a�^landseapeoregon.com Urinal 25.02 •
_ - CONTRACTOR •
Water closet 25.02
- - -=, -••••• . . _ - -- - -- - . Water heater 37.52
Business name: Landscape Oregon, Inc. WaterpipingJDWV 56.29
Address: 12200 SW Myslony Road Other: I 2502 _
City /State /ZIP: Tualatin, OR 97062 Subtotal 3I.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum pemtit fee: $72.50 72.50
Plan review (25 %ofpermit fee)
CCB Lie.: 7804 11130/1 Plumbing Lic. no.: -
State surcharge (12 %ofptxmit feel 8.70
Authorized signature t!. -- . G,'1 �.-e..L(--i TOTAL. PERMIT FEE r 81.20
Print name: Ellen Sparrow Date t� This permit application expires if a permit Is not obtained within 180 days
7 " - after it has been accepted as complete.
^Fee methodology set by Tri- County Buildiep Industry Service Board.
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