Permit CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00281
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/26/2012
Parcel: 2S110CB10500
Jurisdiction: Tigard
Site address: 15480 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 93 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 93
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 - 387 -7577
HONE: 503 - 692 -5945
FAX: 503 - 692 -0768 •
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 09/26/2012 $31.27
Specifics: 1 12% State Surcharge - 09/26/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 09/26/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
J'l Issued By: A ` Permittee Signature: pig I 4 P � v �
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. r '�f �-�`f 1 C
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application P( E JF'
Building Fixtures i .� - FOR OFFICE USE ONLY
City of Tigard SEP 2 6 201 Received Pct-u;t No.;
• 13125 SW Hall Blvd., Tigard, OR 97223 Date/By. ail )-/of l �" pi-44 two - 619 age, I
Pl
Phone: 503.1182439 Fax: 503.598.1960 ,� ay. TIGAROD .' Other PermitNo�$�O(2:.- OD /wa-k
inspection Line... 503.639.4175
TIC A R D t � 1 1 BI p tLD C'��� ^ D ( VI Datc a RcadY�Y Ef See Page 2 for
Internet www.tigard or.gov t t ljotifi�'Methad: I i 1 Supplemental Information
:.::. TYPE' OF . WORle ' :... . . ... ...
>.: ..::::.:':;- :::.:_ : :;, :.:r :.,. . -. : - FEE *'SCH
,:,.::,..... , -_.. • :�..,. -::• :. :: � . - ...- _ :_ DUGS : :�.:;. _... -
® New construction ❑ Demolition Forsperiol information use checklist, 1
Description I Qty. I Ea [ Total
❑ Addition/alteration/replacement ❑ Other. New I- 2- family dwellings (includes 100 ft. for each utility connection)
_ '.CATEGORY OF ::CONSTRUCTION .: = : rs..: . ; SFR (1) bath I 312.70
1- and 2- family dwelling I 0 Commercial/ndustrial SFR (2) bath 437.78
[3 Accessory building ❑ Multi-family SFR (3) bath 50032
Y
❑ Master builder Each additional bath/kitchen 25.02
❑ e
'Fire sprinkler
-.. ` ''' '_ •• JOB SITE. INFORMATION �AND"LOCATION -: _ : ; ; `::; : . Site utilities:
Catch basin or area drain 18.76
Job site address: ! S / 76 c.-L4.411 fn C-i u 1 . G 0 b,-, t
y Drywell, leach liue, or trench drain 18.76
City/State/ZIP: 77 C cc LCL C tZ /
of '7 ',- ---
Footing drain (no. linear ft: ) _ Page 2
Suite/bidgJapt. no.: 0 Project name: -j/ � i r ly e7 3 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S e.c f- IS-g it-C(.. IC' V7 , Rain drain connector 18.76
Sanitary sewer (no. liner ft.: ) ; Page 2
Storm sewer (no. linear t''-.: _) Page 2
Water service (no. linear ff.: _) Page 2
Subdivision: P'}'/ 1 t i e / f'e71 .1! i'l, -' I Lot no.: 9 Fixture or item:
Tax map/parcel no.: C.e SS f Backflow pieventer x 31.27 I 31.27
:. ae to v vc
,; ::
I ...::.-::..�:._ __ • _ _ _:: _ :WORK:. :. _ : - _..,
Clothes washer 25.02
Landscape Irrigation Back Flow Device
■
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
- .' . : 1 .:::' .
---. -PROPERT]' O.WNER' ' :.:::: - :; ;: i : =;_ - . ° .. - -- . Ex anston lank �
.: ... ..... __. .. -: .: : , .... - _.. _❑ TLNi1:NT= ,r= :: "'.:, P I_Sl
Name: Stone Bridge Homes NW LLC Fix urcisev'ercap 25.02
Floor drain /floor sink/hub 25.02
Address: 4230 Galcwood Street Suite 100
Garbage disposal 25.02
City /State/ZIP: Lake Oswego, OR 97035
Hose bib • 25.02
Phone: ( ) Fax: ( ) Ice make: 12.51
.._
:: .:_. :: ®APPL1CPiNII'.'::..:.:. i: - :--- ; _.! ; -: CONTACT PERSON =` .i!..4.-1 Interceptor;grease trap 25.02 • Business name: Landscape Oregon, Inc. Medical gas (value: 4 ) Page
Contact name: Ellen Sparrow
Primer [ 2.51
Roof drain i commercial) 12.51
Address: P.O. Box 2386 Sink/basin:lavatory I 25.02
•
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 1 Fax: : (503 -) 692 -0768 Tub/shower /shower pan 12.5:
E -mail: ellen®landscapeoregon.com Urinal 25.02
ter et
CO.�l'FRACTOR -
°I 2 5.02
Water heeler
37.52
• Business name: Landscape Oregon, Inc. •
Water pipineDWY 5629
Address: P.O. Box 2386 Other 25.02
City /State/Z1P: Tualatin, OR 97062 Subtotal 31.27 •
Phone: (503) 692-5945 Fax: (503) 692 -0768 Minimum permit fee: 572.50 72.50
CCB Lic.: LCB 7804 Plumbing Lic. no.:
Plan review (25% of permit fee)
. State surcharge (12% of permit fee) . 8. "0
Authorized signatu, -, 7 C(/L t., I TOTAL PERMIT FEE I 8110
This permit application c. res.if a permit is not obtained within ISO days
Print name: Ellen Sparrow Dat e / f � 1 . .� p� app p�
/ / ( after It has been accepted as complete.
'Fee :methodology set by Tri -County Building !ndusYy Serv.ce board.
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