Permit q CITY OF TIGARD PLUMBING PERMIT
111. is , COMMUNITY DEVELOPMENT Permit #: PLM2012 00300
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: 2S109DA14300
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Jurisdiction: Tigard
Site address: 12603 SW MOUNT VISTA CT
Project: Arlington Heights No. 3, Lot 62 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 62
Project Description: (1) backflow preventer installation
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
12200 SW MYSLONY RD 4230 GALEWOOD ST SUITE #100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
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PHONE: 503 - 387 -7577
HONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/17/2012 $31.27
Specifics: 1 12% State Surcharge - 10/17/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 10/17/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' I _ Permittee Signature: i 1 T/� /1 AP ./) ^' "21U/it/ n t
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. f 1 i" +
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED. Plumbing Permit Application .
Building Fixtures OCT I U 2012 FOR OFFICE USE ONLY
City of Tigard ` 11Y OF 11GARD Re:
r Permit No.: , ...
• 13125 SW Hall Blvd., Tieard, ORI 9' D$NG DMQ 'vt, '� �� BY (0/ �7 /� S'f PLJN p1,Q 4 04,41. - b0
- lyJ�tJ v Plan Renew
Phone: 503.7182x39 Fax: SOS.S g�+ Other Permit Na S rt�/ : � 2.- poi •
DnteiBr
Inspection Line: 503.635.4175 I
TIGARD Date Ready/By: in PI See Page 2 for
I
Internet: www.ngard- or.gov
Notifi :tLllcthad 1 f Supplemental Information
L - ..
TYPE! OF YO RK.: ... -: - .. _ . .:T.. . _ -
; ' � FEE* SC • ..: _ •
g New construction ❑ Demolition For apecial information use chechlisx
Description I Otv. I Ea- I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2-family dwellings (includes :00 ft. for each utility connection) '
CATEGORY OP . ONSrRUCTION.:
C ., SFR (1) bats 312.70
® I - and 2- family dwelling ❑ Commercial/industrial SFR (2) bat11 437.78
SFR (3) bath • 500.32
❑ Accessory building ❑ Multi - family •
❑ Master builder Each additional bath/kitchen 25.02
❑ Other. Fire sprinkler ( sq. ft.) Page 2
_ JOB - SITE INFORMATION ANN_ D. LOCATION' __._. Site utilities:
Job site address: Catch basin or area drain 18.7E
City /State/G1P: ] ] C , C C � C 3-0 Dtywell, leach lire, or trench drain 18.76
Suite/bldg./apt. no.: Project name: /- fry-) Footing chain (no. linear R: _) Page 2
A- r f ( � � � 1 4r' �f Man ufactured home utilities 50.03
Cross street/directions to job site: , Manholes 18.76
S - u - m p-r tJ i c--u -% L�/ziA.,«�. Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) ' Page 2
Storm sewer (no. liacar ft: ) . Page 2
Water service (no. linear R: ) Page 2
Subdivision: fry) / dihIl f -LC-'I 6A-4-5-. Lot no.: 6a.- Fixture or Item:
rc
Tax map!pael no.: ✓ 0 5---• 6 Backfowpreventer x 31.27 31.27
- .., . _ .. F ,- : Backwater valve
12.51
_ :., . , . ,_ ... _ DESCRIPTION i0 WOItIC . - : -
- - - _
Clothes washer 25.02
Landscape Irrigation Back Flow Device
Dishwasher 25.02
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t
Drinking fountain 25.02 •
• Ejectors/sump 25.02
_ el PROPERTY OWNER - - -, - : -' = - _ _ 1:z yErrArrr . Expansion tank 12.51
Name: Stone Bridge homes NW LLC Fixture/sewer cap 25.02 ,
Floor drain/floor sink,'hub 25.02
Address: 4230 Galewood Street Suite 100
Garbage disposal 25.02
Ciry!State /ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) ;Fax: ( ) Ice maker 12.51
_ : APPLICANT' r t :- •
. - _ : I ®: COATAGT PERSON latecceptorgrease trap 25.02 •
Business name: Landscape Oregon, Inc. i Medical gas (value: S ) Page 2
Contact name: Ellen Sparrow
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• 12.51
Roof drain (commercial) • 12.51
Address: P.O. Box 2386
I Sink/basin/lavatory 25,0^
City/State/ZIP: Tualatin, OR 97062 i Solar units (potable water) 62.54
Phone: (503) 692-5945 ;Fax:: (503 -) 692 -0768 ' Tub/shower/shower pan 12.5] .
E -mail: elieu @landscapeoregon.com I Urinal 25.02
- ,
, ..
Water closet 25.02
- •CONTRACI'.OR -
- - . ' • • - ' _- _ . - Water heater 37.52
Business name: Landscape Oregon, Inc. WaterpipirtF,DWV i 56.29
Address: P.O. Box 2386 Other I 25.02
City /State!ZIP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee: 572.50 72.50
1 j Plan reuiew (25% of permit fee)
CCB Lic.: LCB 7804 Plumbing Lie. no.:
State surcharge (12% of permit fee) 8.70
Authorized signature:/ n ` fa,1...4..) TOTAL PERMIT FEE 81.20 ,/
I Print name: Ellen Sparrow • I Date :R) / Ile/x/4_, This permit application expires.if a permit is not obtained within 180 days
1 after it has been accepted as complete.
i i `Fee methodulogy set by Tri - County Builcing Indust :y Service Band_
1:.nuildia ;LPen. t :s•P_V11- ?ermitApp.doc 10.'01/09 440.4E 16T(1C.C2/COWWEBI
Z'd 89LO Z69 - £09 uele d09:ZO Z1. 91. PO