Permit CITY OF TIGARD PLUMBING PERMIT
I • COMMUNITY DEVELOPMENT Permit #: PLM2012 -00212
T E GA 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/2012
Parcel: 2S109DA18200
Jurisdiction: Tigard
Site address: 15185 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 111 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 111
Project Description: (1) Backflow preventer
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 07/31/2012 $31.27
Specifics: 1 12% State Surcharge - 07/31/2012 $8.70
• Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/31/2012 $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 ,/1 /�/L & / 7 or 1.800.332.2344. I �
Issued By: AAA,/ it I► ,f n ' Permittee Signature: r ` , ! 0? 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.
•
Plumbing Permit Application RECEIVED
Building Fixtures JUL 26 ,,_ FOR OFFICE USE ONLY
City Ti ei yed
tJ' Tigard �.gr 1 I V r L Permit v„ fm 019( 07 .. eva 1a,
1 .T. a 13125 SW Hall Blvd, Tigard, OR 97223
OFTIG • wfcw
• ,29
Phone 503.718.2439 Fax: 503.598.1960 �` : .• O t h er P erm i t '.1q57 / a -o O
InspectionLiirc: 503.639.4175 BUILDINGDIV '! ' !
T 1 G A R O Internet: www.ti rd-or, v '� : odyBy: / I gu S ee m P ve 2 ror
Internet: $i 3A' NMified�'Yfet[>,id: tippleeotal [nfermaNOn
TYPE OF VI'ORK.::::_:: - _.. NEE SCIIF.DIil.lz •
®New construction El Demolition For special information use checklist
Description I Qty I En. I Total
❑ Addition/alterationireplacemem ❑ Other. New I- 2 -famlly dwellings (includes 100 ft for each utility connection)
;. -.__ ' • CATEGORY. _OF CONSTRUCTION SFR (1) bath 312.70
® l- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
'SFR (3) bath 500.32
❑ Accessory building ❑Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
' Fire sprinkler ( sq. ft.) Page 2
_ • . :__ ; _ JOR!:SITE INFORMATION AND?LOCATION ° - • Site utilities: •
lob site address: 1 S (gs S {,1,YY1 rn .e r y (� 3 Catch basin or area drain 18.76
Y I ./� Drywell, leach line, or trench drain 18.76
City/State/ZIP: 7 (c3' a.,r t._. d /Q-- q - 2 , ,-0--3 Footing drain (no. linear R: ) Page 2
Suite/bldg. /apt. no.: - I Project name: t hn y-% l 1 / Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18.76
B e, e .F 134/1...0.-1 a p Pj / ,r Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
S (.i./YI next-r tit 2u�
Storm sewer (no. linear ft.: 1 Page 2
Water service (no. linear It.: _) Page 2
Subdivision: / I nq ] 1 , G V I Lot no Fixture or item:
Tax map /parcel no.: ! Co .sy 7 Backflow preventer x I 31.27 31.27
- ac 12.51
.::_
. - -- .. _._ ESCRiP'CION OF VNOR[C - = ::::.: _ ::::.:: . .. ...
Clothes washer 25.02
Landscape Irrigation Back Flow Device
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
-_"®' PROPERTY OWNER :; -.: :: '.' =' :::: :::.❑ TENANT , ..; i , Expansion tank 12.51
Name: Stone Bridge Homes NW LLC Fixture/sewer cap 25.02
Address: 4230 Galewood Street Suite 100 Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) i Fax: ( ) Ice maker 12.51
: -. . " _ ® "APPLICANT " -. -. _. - = .. ® CONTACT" PERSON InlereePlneVrase trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: S ) Page 2
Primer 12.51
Contact name: Ellen Sparrow
Roof drain (commercial) 12.51
Address: P.O. Box 2.386 Sink/basin/lavatory . 25.02
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone; (503) 692 -5945 I Fax: : (503 -) 692 -0768 Tub /shower /shower pan 12.51
E -mail: ellen@alandscapeoregon.com Urinal 25.02
Water closet 25.02
- .
. - . - ._ CONTRACTOR _.. Water
heater 37.52
Business name: Landscape Oregon, Inc. _ Water piping /DWV 56.29
Address: P.O. Box 2386 Other. 25.02
City /State/ZIP: Tualatin, OR 97062 Subtotal 31.27
P)tone: (503) 692 -5945 Fax: (503) 692-0768 Minimum permit fee: 572.50 72.50
/ Plan review (25% of permit fee)
CCB Lic.: LCB 7804 Plumbing Lic. no.:
State surcharge (12% of permit tee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: Ellen Sparrow Date: f ' f y This permit application expires if a permit Is not obtained within Lao days
p I • l•' �V(� after It has been accepted as complete.
`Fee methodolo(i'set by Tri- County Building Industry Scrvioe Board.
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