Permit CITY OF TIGARD PLUMBING PERMIT
Permit #: PLM2012 -00205
11 1- ,.. COMMUNITY DEVELOPM
Date Issued: 07/25/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 2S109DA17500
Jurisdiction: Tigard
Site address: 15333 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 104 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 104
Project Description: Irrigation backflow device.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 4230 GALEWOOD ST SUITE 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 07/25/2012 $31.27
Specifics: 1 12% State Surcharge - 07/25/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/25/2012 $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. Al'
Issued By: Permittee Signature: ON �, , q 0
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.
Plumbin Permit A Heath)
Building Fixtures
- City of Tigard JUL at / . r S
a 13125 SW Hall Blvd, Tigard, OR 97223 L 2 3 20 12 Date'By 493/- Permit No., /
Plan Revie v
Phone: 503.718.2439 Fax: 503.5t8NV � Other Permit No � o 24 Y /� 2 - 40087
Inspection Line:' 503.639 p Dat Re ed By: rya: See Page 2 for
T[ GAR D I nternet: www.tigatd or.gov BU r r D ale Notif ied;Metllod: ( � Supplemental Information
R.D IN(3P I V ISION '�
TYPE OF W ORK ' ::: •:::_.::::.:_::. .. .. . FEE* SCHEDULE .. __ •
® New construction ❑ Demolition For special information use checklist.
Description 1 Qty. I Ea. I Total
❑ Addition/alteration /replacement ❑ Other New 1- 2- family dwellings (includes 100 R for each utility connection)
. CATEGORY OF CONSTRUCTION . ..... . • SFR (I) bath 312.70 •
® 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
El Accessory building SFR (3) bath 500.32
❑ Multi-family
Each additiotnl bath.'Idtchen 25.02
❑ Master builder ❑ Other. : Fire sprinkler ( sq. it) Page 2
. JOB SITE INFORMATION AND. LOCATION_ .___ -. ... Site utilities:
Catch basin or area drain 18.76
Job site address: / 53 33 ,c'LL f v / €.1.•C..t 0 0 (..'
Dry leach line, or trench drain 18.76
City. / State/ZIP: rc J U e) -7 a-p_tf Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name:/ 1n 9 t ri I CX/ Manufactured home utilities 50.03
Cross street/directions to job site: l Manholes 18.76
n e t f I. e tAct e l tern m c,- V ( .w) Dr/ LE , Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear ft.: _ ) Page 2
Subdivision: Phil/ (')d/7 / c . q Lot no.:/0 L/ I Fixture or item:
Tax map /parcel no.: Co SS' /4-(n Backflow preven:er I x 31.27 31.27
- • DESCRIPTION: OF WORK • _ . :
Backwater valve 12.51
- Clothes washer • 25.02
Landscape Irrigation Back Flow Device
Dishwasher 25.02
Drinking fountain 25.02
Ejectors:sump 25.02
... .._
• ;® PROPERTY OWNER = . 13 TfuNANT: . Expansion tank 12.x1
Name: Stone Bridge Homes NW LLC Fixtureisewercap 25.02
Floor drain/floor sick/hub 25.02
Address: 4230 Galewood Street Suite 100
Garbage disposal 25.02
City / State/ZIP: Lake Oswego, OR 97035 Hose bib 25.02
. Phone: ( ) Fax: ( ) Ice maker 12.51
. ® APPLICANT •®CONTACT PERSON . i Interceptor/grease trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: $ ) Page 2
Primer 12.31
Contact name: Ellen Sparrow
Roof drain (commercial) 12.51
Address: P.O. Box 2386 Sinkbasin %lavatory 25.02
City /State/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 l Fax: : (503 -) 692 -0768 Tubishowerlsllowcrpan 12.51
E -mail: ellen@landscapeoregon.com Urinal 25.02
- CONTRACTOR .._ :_ Water closet 25.02
Water heater 37.52
Business name: Landscape Oregon, Inc. • Waterpiping'DWV 56.29
Address: P.O. Box 2386 Other. 25.02
City / State/ZIP: Tualatin, OR 97062 • Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 I Minimum permit fee: S72.50 72.50
CCB Lie.: LCB 7804 Plumbing tic. no.: Plan review (25% of permit fee)
�/ State surcharge (12% of permit for i 8.70
Authorized signature ei( .n a c) TOTAL PERMIT FEE 81.20
✓✓��l! / Thb permit appaation expires if a permit Is not obtained within MD days
I Print name: Ellen Sparrow Dabt { / a 3 �r.� after It bas been accepted 1.b complete.
. *Fee methodology set by Tri -County Building Industry Service Beard.
I: Build 'vigtramhsa'LMU -PmuilApp.coc l aO1:09 440.46:61110.02 +COM!WEB)
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