Permit •
CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00141
13125 SW Hall Blvd., Ti an OR 97223 503.718.2439 Date Issued: 05/30/2012 • —
T [ C; AK f7 9 Parcel: 2S109DA18800
Jurisdiction: Tigard
Site address: 12706 SW WILLOW POINT LN
Project: Arlington Heights No. 3, Lot 117 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 117
Project Description: Landscape residential irrigation backflow device
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 4230 GALEWOOD ST, STE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
P
PHONE: 503- 387 -7577
PHONE: 503 - 692 -5945
FAX: 503 - 692 -0768 •
•
• FEES
Quantity Description Date Amount
•
1 ea Backflow Preventer 05/30/2012 $31.27
Specifics: 1 12 %,State Surcharge.- 05/30/2012 $8.70
Plumbing
Type of Use: SF - 41 ea Minimum Fee Adjustment - 05/30/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp: •
Stories:
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•
•
•
•
Total $81.20
Required Items'and Reports (Conditions)
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This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is, suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
A ko b dti •
Issued By: Permittee Signature: Old /Tf p (_ATI o*i
• Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be•kept in,a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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r
May 28 12 02:35p Ellen :
503- 692 -0768 p.2
• 1; 1( ei
Plumbing Permit Application ?O r"--
Building Fixtures Tmm FOR OFFICE USE ONLY 6'
Received ► � s t r PcmitN f 00(ii-1
11 City of Tigard MAY 2 9 r�atdBy: 71
- 12 Phone: SW 503.639.4171 Fax: 503.59Hall Blvd., Ti OR 97223 9 2012 Plan Review Other Permit No�($(.)OI p
one 50b 'Q, DateoBy
F F �' • Date Ready/By: w� 1 Et See Page 2 for
Iaspectioa Line: 503.639.4175 y Ti > A l� Supplemental format
TIG!lRD Internet: www.tigard•or.gov U.„:„. I h � RD Notified/N•et od: _ _ _ - -r ,c ! - -
Fo
► L~ : , fir^ `'? - 1
- 77 ._ .. -: s l!� _ - _- - - _ -- � ���c�v ;i - - _:Y. ;� � ��.i°
k::e:�!L: e ..:. - :7777_{ • .E•� _ - - - _ . - ._. 77-_7. - i- -
TYPE , tj� -- ORi
..- ._ daf rrn
7_777. _ ..-. '
_ _ • -- _ . - ... . info adon use checklist
CE New coast ucdon _ Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ( 11 Othel?. New 1- 2- family dwellings (includes 1I 0 ft for each utiiity connection)
.,,: e?- SFR (1) bath 312.70
•,,; _ _ _ =_;F_ J _ ,,) - CO. IO ' - r:° .. _ 2 437.78 . : P - :'' C ; ., •r «77 7_7_, 437.,
I �: ; _', ; ;'�'i.�- .�. ; ':�; i a-•• -- _ ---. _ -. i � .1
„...�.- .. :'•'.= 4:v;- SFR(2)bath l -
® 1- and 2- Family dwelling ❑ Commeroialfindust ia! SF ti (3) bah I 500.32
❑ Accessory building ❑ Multi- family Each additional bathltateaea 25.02
I I:I Master builder 1 0 Other. r "ire sprinkler (__ sq. ft) Page 2
-_ m V'' ' :_ 1 _ r.: - - Rithile A'ND' LOCj►TIOAi _ : 's site utilities: ,
=,R•= =JOB SITE IT1F0 7777_. _7777 t dr 1876
�.. _. i.. =Ibteor Job site address: ! a' - 701;' LA I (J uJ t n� C L' 113.76
City /State/ZIP: Ti Cj fc /td.. 0 el 77 p'')- 7 Footing drain (no. linear ft.: _) Page 2
t •-/ i �q 'yl 117 Manufactured home utilities _ 50.03
Sttite(oldgJapt. no.: I Project name• l
Manholes 18.76
Cross street/directions to job site: 18.76
Rain drain ooanector _
S CA-) (j C °� -f jt ' !> Gl_ "� 51.1 M C4�` V (�) n- S anitay sewer (no. linear R.: _____) Page 2
£ - en-to )1 1 (r L(..) P 1 A (LNR- Storm sewer (no. linear ft.: rJ Page 2 •
Water service (no. linear f..: __ J . Page 2
Subdivision: All i n 'fir ir . • I 1/L Lot no.: 9 _ Fixture or item: • Bacl�OW preventer x 3 L2; I 31.27
Tax map/parce no.: S S .. _. - - -•_ :,_ _ Backwater valve 12.51
- .. "-' OF `! `' 25.02
- _ ; � � .� ; ;�1` -� -� ;= =�; .�y�'�ESt�'FI - - ' '. - - . ° , , _ - _ ., . .:., , 77 77 Clothes was
. - 77
' -i n: q � . .:..�.a "e g g; : .,. 77 77.. .
Landsc • r • Irrigation Backflow Device Dishwasher 25.02 -
/eFfrG�iJTigL
-) Drinking fountain 25.02
Ejectors/sump 25.02
,
_ ?, Expansion tank 12-51
��.�r�` - ' - . ®. rRO�:r�t:� 7777 �._ :.t: _, , :. -
.:1�„ �:. .,_.- ,1E,:= ,� ;., -:r � - _., - `l� Fixttaersewer cap 25.02 •
Name: StoneB ridge Homes NW LLC Floor drain/floor sink/hub 25.02
Address: 16869 SW 65 #505 Garbage disposal 20'02 1
City/State/ZIP: Lake Oswego, OR 97035 Hose bib
[ 25.02
Ice maker 12.51
Fax:
Phone ( ) _ .if..-F':::7,, _ ? _) . . h; : . lntercepto:!grease trap 25.02
- figi! -::O i,'is - - � '`IC4�T' r'i� ' `s._ i.:t , ` _
�:1�. "aPJi' _ ga s (value: S �) Page 2
......... air - ..�' Medical (value:
name: Landscape Oregon, Inc. Primer I 12.51
Contact name: Ellen Sparrow Roof drain (commercial) 12.51
Address: 12200 SW Myslony Road Sinldbasin. ° 25.02 avatory _
City/State/ZIP: Tualatin, OR 97062
Solar units (potable water) 62.54
Tub/shower/shower pan 12.51
Phone: (503) 692 -5945 Fax : (503) 692 -0768 Urinal 25.02
E- mail: ellenta�landscapeoregon.com _ Water closet 25.02
- si'y } -.; .�_. i- . ; ; 'tc _; i;.t a _ _a = ❑ _ _ _ i ° P �
J It.tia e•_t .- _% , R_' , `" _�.1 :.. i _ - �" Water heate 37.52
i.:_. _ ,_ :. � `7,777!
d E
.. ,777 [:�
Business name: Landscape Oregon, Inc. �: p:ping/DV,N I 56.29 '
Address: 12.200 SW Myslony Road Other: 25.02
Subtotal 3127
City /State/L2: Tualatin, OR 9706.'
Minimum permit fee: 572.50 72.50
•hone: 503 692 -5945 Fax: (503) 692 -0768
'hone: ( 503) _ Plan review (25% of permit fee)
CCB Lie.: 7804 Plumbing Lie. no.; S :ate surcharge (12% of permit fee) 8.70 / • Authorized signature t ,) v i.trt - 1- TOTAL PERMIT FEE , 8 -2
This permit application expires if a permit is not obtained within 180 days
Print name: Ellen Sparrow i DateS t ..) O~ _ after it bas been accepted as complete.
_ -Fee mahodclog sct by Tri -Count' Building Industry Service 3oard.
t: lBuilcme .PetIIllltALMU•PO'rnk.4p7.dae NV 1(09 4404615T(t 0/O2.'C0WWEB)