Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00105
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2012
Parcel: 2S109DA15500
Jurisdiction: Tigard
Site address: 15298 SW GREENRIDGE PL
Project: Arlington Heights No. 3, lot 74 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 74
Project Description: Residential backflow preventer for irrigation.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 4230 GALEWOOD ST, STE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 387 -7577
HONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
ea Backflow Preventer 05/04/2012 $31.27
Specifics: 1 12% State Surcharge - 05/04/2012 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 05/04/2012 $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 ques inn- to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B ; , / Permittee Signature:
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.
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Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard
13125 Permit No.: Paifip /it DO IOj
11111 - 13125 SW Hall Blvd., Tigard, OR 97223 . I•Y - 2 2 Z Flan Review Permit No.: }/��/ DD /?,
P hone: 503.639.4171 Fax: 503.598.1960 Date/By:
RD Inspeeaon Line: 503.639.4175 CITY OF TIGARD N t c ea Me ho: '""T Supplemental See Page . or
'on
information
71c� Internet: wwlv.ugard -0r.gov BI.I1LD1NGD.LVISIQ I _ �
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'.I N For special information use checklist
New construction ❑ Demolition Description I Qty. I Ea. I Total
❑ Addition/alterationteplacement ❑ Other. New i- 2- family dwellings (includes I00 ft, for each utility connection)
-- ,, =9 v _ = :- '? SFR(1)bath I 312.70
E,,>_::; _- -- _ ,. -- : ATl'GOR]etO .ONSI'RUC710 \_ - -_ - --; _
YS; ° :�a�S` "�, -..... : -. . ., -..- r= ,. . :-w :_,, :, "�- : " --`'� -
-• - - SFR(2)bath I 437.78 •
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (3) blast 50032
❑Accessory bolding ❑ Mula-family I each additional bath/kitchen " 25.02
❑ Master builder ❑ Other � Fire sprinkler (_ sq. ft) I Page 2
, ,;,... :.,. . : �._'- <<�; : :- - • -- - - -- _ _ . iz Site u tties:
t :: - °
JOB ' - SITE IN£di g;i4 (N iii0 OO ii lii: .: _s ° •• ili 18.76
e.Y tf Catch basin or area drain
Job site address: / g p f C(t (,. D- ywell, leach line, or trench drain 18.76
City /State/ZIP: 'r(l iL(/LC . Q 1Q, .9 T] Footing drain (no. linear ft,: _) Page 2
SuitetbldgJapt. co.: U ' Project name: Af( / ;'- tit yL 7c7 Manufactured home utilities 50.03
Cross sweet %directions to job site: Manholes •
/ 18.76
p� e 2 . 1 Rain drain cannaconnector • 18.76
rX ( 6-efl- k L D 7 S. L i.i71 M�' -t c' Zt.•(� -7
Sanitary sewer (no. linear ft.: _) ` Page 6
I>_ c-71. 72 --N) e - eleine,✓t_r P (CL ace. l -k- 0 ri Storm sewer (no. linear R: ,J Page t
+I AA- / 0 Water service (no. linear ft.: _J . Page 2
Subdivision r/ i r ci tr J .L q /ifs- I Lot no.: 7 '--/ Fixture or item:
Tax map/parcel no.: Cp • ; _ Backwater ve x I 12.51 31. 7
, .. ✓ , F ! '7� I• af�� . � •. .. = d- :f- ' +■
, .:. ';�: � �� :.° wp�ertt •
- _ . - i _ - � ' „ „ , cr,;� ., �ES: -�. C.'FZY�'1'�ON•___. • -._. • -�'. .. _ � .:� ` =I.' _Fi 25.02
:i�ilr _ ��r : .
6i -_'� ::
`.. :'(, ; :... _ _ Clo*.hes waster
• Landscape Irrigation Bacldlow Device Dishwasher 25.02
Drinking fountain 25.02
- Ejectors/sump 25.02
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,$a. IPROPERT: O V o-? _ , TIr6L�7v3 - _. -
- c v : ..._ ;•; ii ° Funur/sewer cap 25.02
- Name: StoneBridge Homes NW LLC 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: ( )
•,_: G lw,.- .0 }p;' ( ) Ice maker 12.51
- - -= '-CO ALT; _ • ' - Inter /gn�setrap • 25.02
r PERSOTI'
- Er;:= ®i'APPGIC.47 _. :� - : ®,�s..� ,���,� .•___ - .._ - 0 2
- , . ' ` - ` = „ .- Med gas (value: $ ) g
Business name: Landscape Oregon, Inc. ,
Primer 12.51 •
Contact name: Ellen Sparrow Roof drain (cornmert:iel) 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 I Fax: : (503) 692r0768 Tub/showe:lsbower pan 4 12.51
Urinal
E -mail: ellen@landscapeoregon.com W closet
, 25.02
_ _- _ ,1St: _ ` .. - _ _ _ a_ a _ = i � ; n� 37.52
; .._,...: c 1- s.,.,�,.:ii:,;; .; ., :. - f jftttAC1'OR.: - „ Udi' :7lc3 {;=a a .• '', .....;:n:; Water heater
r � � F - '- ' ! "a =_ „; -ry'" .. '� •i =� :' R
Business name: Landscape Oregon, Inc. Water piping/DWV 56.29
Address: 12200 SW Myslony Road
Other: 25.02
Subtotal 31.27
City/State/ZIP: Tualatin, OR 97062 Minimum permit flee: $72.50 72'5'0
Phone: (503) 692 -5945 Fax: (503) 692 -0768
Plan review" (25% of permit fee)
CCB Lic.: 7804 Plumbing Lic. no.: State surcharge (12% of permit fee) 8.70 .
• Authorized sigcaturej2 .L /7 . '"may � 4jO[tt LLrt-- J TOTAL PERMIT "FEE 81.20
Print name: Ellen Sparrow I �., / )) 4_ This permit appllea expires if a permit is not obtained within 150 days
Date: � after it has been accepted ac cnmplete•
"Fee methodology sit by Tri County Bm7dicg lndusry Servix Bid.
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