Permit CITY OF TIGARD PLUMBING PERMIT
3 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00142
Date Issued: 05/30/2012
T I CAKE) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S109DA14600
Jurisdiction: Tigard
Site address: 15238 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 65 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 65
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
PHONE: 503 - 692 -5945 PHONE: 503 387 -7577
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:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance. or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: At/1k Permittee Signature: Y \1 4 r z-! /#it'l77 ylkAbli
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
May 28 12 11:24a Ellen 503- 692 -0768 p.2 t1 e ,
Application � CEIVED T y '(
Plumbing Permit App f0
Building Fixtures MAY 2 9 2012 FOR OFFICE USE ONLY 1
PcReceived 1 r
City of Tigard IN OF TIG Re ei S� J e etm;t r [4� DJa � COI �3- / 0
- 13125 Phone: SW Hall Blvd, Tigard, : 503.639.4171 Fax: 5 Ojt . ' 3' P:an Review Otba pm - 4 ,� �Q�7
hone .1 - .+ :);i1 OI DIVISION DareBy: ��
T I G RD Inspection Line: 50_2.639.4175 Date ReadyfB ly
y: f/ I L Sec Page 2 far
• Internet www.;:gard Nati:ted/Method: ( ((0 Supplemental Information
- �� .:: � - - - s�: T1tTE OL? WOR$.. _ i , _ ,,c., - _ _ _ ii: ' ' .... -_ =' � • - LtL �l� 5 �_� : ' : _ j
❑Demolition For special information use checklist
New construction Desc: intion I Qty, I Ea. 1 Total
] Additioly 'altestitxVrepla:.ernent �Othe • _ New 1- 2- family dwellings (includes 100 ft. for each utility connection)
,, „y... n.,•_;-:.;;:c.0,.. T GO OF C -0
R?n'S R UCTTOI ' ,!.
-,. _ _ `lI:> ill!: SFR(1) 312.70
SFR (2) bath 437.78
�$ 1- and 2- family dwelling ❑ Commercial industrial SFR (3) bath 500.32
lO Accessory building ❑ Multi - family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other - Fire sprinkler ( sq. ft.) Page 2
:1- ,40,:.e:-ivl4,e iG T'lON A.'1 [IOCAT iON ; Site utilities:
..� • .
*!'a JOBi;S TIEINFORMA. :m -- - -. .-. : - - - `- ' ...,
Catch basin or area drain I 18.76 .
Job site address: )f S ? (, i_ _ �
('L� ) ' ) I t 18.76
Cl � � Drywall, leach line, or trench drain
City /State/ZIP: T / J JCL C? 1K_ ."7 `7 7•', -`1 Footing drain (no. linear R: _J I Page 2
Suite/bldg. /apt me no.: Project na // j n ) -tZr)1 lL .5 Manufactured horse utilities ' 50.03 ,
Crass street/directions to job site: (� 1 Manholes 18.75
& . -e.F -✓Lc /t.'rn lr�.l'1r 1 f 4,12. . Rain drain cnmte:tor 18.76
Sanitary sewn (no. liner ft: __) Page 2
Storm sewer (no. linear ft.: , ) Page 2
Water service (no. linear IL: ,) Page 2
Subdivision: } j y' TyL., './. (/1.tT Lot no.: , ,s Fixture or item:
Tax map/parcel no.: 1p -- -c' 43 (p Bael:flow preventer x 31.27 31.27 1
K
[•' - •- _ ate ; t :_:,.. -: -- - _ 41 .. 3 . - . _ _ ..:,; Backwater valve 12.51
t •: ; : ; ..,
.. _ . . - • . -- - ,.a
... IS ..
.F. .. , .i: '., _ ( -•.: _ ... y
- : ._ r. _ - r s,; : -. as = a : ,__ - - - .. ..,......... - ..- ' « . Clothes washer 25.02
Landscape rrigation Baeldlow Device Dishwasher • 25.02 .
C4 thriv7/9"L
Drinking fountain 25.02
Ejectors/sump 25.02
_ - ' -.ii :. a; _ =_ '_. isr:a :: II':' _ -'� s e „ . -.. _ �'4 . __y: Eie tank
12.51
® =PROPERT;]•.:1jW1ER; _-- - _ - ' TE. \41i F' = E ,
- • - Fixture/sewer cap 25.02
Name: S toneBrid a Homes NW LLC
0 Floor drain/floor sink:hub I 25.02
Address: 16869 SW 65 Ave #505 Garbage disposal 25•02
City /State/ZIP: Lake Oswego, OR 97035 Hose bib 25 .E
12.51
Phone: ( ) Fax ( ) Ice maker I 25.02
=t 1
r:.r '0 •=q H a; - - ' ` %,_ ? : - Interceptor /grease trap
,,i i:; { ti , ®` I� ' . ' _ " :] - N BP C . ., !. _. : -! __ RSO\ _ _
Business name: Landscape Oregon, Inc. Medical gas (value: S ) Page 2
Printer I2.51
Con n et name: Ellen Sparrow Roof drain (commercial) 12.51
Address: 12200 SW Myslony Road • Sirk/basin/Iavatory 25 .
City/State/ZIP: Tualatin, OR 97062 Solar units (potable, water) 62.54
Phone: (503) 692 -5945 Fax Tub/shower /shower pan 12.51 : (503) 692 -0768 25.2 •
Urinal
E-mail:
ellen@landscapeoregon.com
.. l6raty closet 25.02 •
: :a _ 4 _ T, j;-: a .CQNLii►.CT Q E :a ., - 1,, n-,.1...:.,!. : _. :1..:,._.._ 3 .52 1
F:.1.-", _ r�:�.. -. _ .. :: � v _ i ....... Water h eater I
• Business name: Landscape Oregon, Inc. Water pipine,/DWV 56.29
Address: 12200 SW Myslony Road Other: 25.02
Subtotal 31.27
City/Stater/1P: Tualatin, OR 97062 Minimum permit fee: 572.50 72.50
one: (503) 692 -5945 I 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 signature�. (.(.� /-� .- -u
.1 -- TOTAL PERMIT FEE 81.20
This permit application expires it a permit is not obtained within 180 days
Print name: Ellen Sparrow Date: I a-O 1%4_ after it bas been accepted as complete.
*Fee methodolou set by Tti -Couny Build:es Industry Service Board.
l Aaundir$w ,itstrL.vtu•Pe>m;t .4oc 10.41/N 440.4616T(10 e'2/COMN.'EE)