Permit I
• , CITY OF TIGARD PLUMBING PERMIT
41 1 -• COMMUNITY DEVELOPMENT Permit #: PLM2012 -00336
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2012
Parcel: 2S109DA17300
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Jurisdiction: Tigard
Site address: 15367 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 102 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 102
Project Description: Irrigation backflow device.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
PO BOX 2386 4230 GALEWOOD ST SUITE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
P
PHONE: 503 - 387 -7577
PHONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES .
• Quantity Description - Date Amount
1 ea Backflow Preventer 11/19/2012 $31.27
Specifics:, 1 12% State Surcharge - 11/19/2012 $8.70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 11/19/2012 $41.23
Plumbing
Class of Work: OTR
Type of Const: -
Occupancy Grp:
Stories:
. Total $81.20
Required Items and Reports (Conditions) '
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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: Permittee Signature:
. 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 Applicatiof iECEIVE 1
Building Fixtures FOR OFFICE USE ONLY
City of Tigard
NOV 15 2012 R„,
M • :3125 SW .7 11 Blvd., Tigard, OR 97 T'^ 01Z Da-Tzar-7 . � / / f / PDrmit No. P(�A igO3 ,
IIUPrf11J PlanRe% t/ I Phone: 503.718 7 439 Fax: 503593.1 OilerPertnitNo.:
(�� � n � I /� Cfre43y
lrtsoecriou Line: 503.639.4175 BUILDING DIVISION ISION dy ; �" � ® Sec Pa_c 2 for I
- C 1 G A R D Da:e Rca ern:
Internet ww•.v.tigard•or.gov NutificdNicil:od: Supplemental Information
. . . - - : . TYPE ' , OF: WORK . : : - FEE. SCHF
. _.. . - -. __, = : ..DUE.
® New construction 12 Demolition For special information ore checklist.
Descnption I Qty. ) Ea. I Total
❑ Additionialteration/replacement ❑ Other: New 1- 2-family dwellings (includes 10G ft. for each utility connection)
___.
:. . CATEGORY. CONSTRUCTION:: ; : ; : _ - ;- ; SFR(1)bath 312.70
bath 437.78
2)
® rrl
1- 2- family dwelling ❑ ComerciaUindust:ial SFR (2)
❑ Accessory building ❑ Multi family SFR f3 i bath 500.32
Each additional bath/kitchen I
sp 25.02
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❑ Master builder Other. Fire rinkler J sq. ft.) Page 2
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❑
- JOB SITE INFORMATION; AND LOCATION i Site utilities: •
(�
Job
� Catch basin or area drain I 18.76
S
site address: i 3 ( "1 .c , ry YY1't•," 1.'i ;..(_c_i 0)� .
City /Sta1dZ�: j[ G Diywell, leach line, or trench drain 18.76
r �t L t GL L ■ J` 1 2 -� ,
Footing drain (no. linear ft.: _ ) Page 2
Suiterbldglapt. no.: Project name
i 1 1 1 C •{ 1.1� ✓' 0 Z Manufactured home utilities _ 50.03
Cross street/directions to job site: Manholes 18.76
tit i i / 6 l"-' P6 l I't 4' { (l i1 L Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear R.: _) Page 2
n �� Water service (no. linear ft.: _ ) - Pace 2
Subdivision: 4-s/ j) r"1 c� - 6-r) j-{-e.Q C:{ /'iS Lot no.: 1 02 Fixture or item:
(
Tax maplparcel no.: , SS 4 7 j J cldlow preventer x 31.27 31.27
:: _. , .. _ - .. _ . - DFSCRIP'I'IONaOF :WOR,iC : ' _ . : : :. - - - - -
: -
,... . .: _ crave
_.... :. - .... Clothes washer 25.02
Landscape Irrigation Back Flow Device Dishwasher 25.02
Drinking fountain 25.02
Ejectorsisump 25.02
®: :PROPERTY_ OWNER ' %' " ::' ' ++ ., :.- [Q,..T.0 IY T,;. ; r! : _ '' Expansion tank 12.51
Name: Stone Bridge Homes NW LLC Fixttlra'sewer cap 25.02
Floor draia!floor sink/hub 25.02
Address: 4230 Oakwood Street Suite 100 •
Garbage disposal 25.02
City/State /EP: Lake Oswego, OR 97035 Hose bib • 25.02
Phone: ( ) Fax: ( ) lee maker 12.51
- ®= APPI:ICANT - ®, CONTACT PERSON:': - Interceptor.'grease trap ' 25.02
Business name: Landscape Oregon, Inc. Medical gas (value S _ ) Page 2
Contact name: Ellen Sparrow Primer 12.51
' Roof drain (commercial) 12.52
Address: P.O. Box 2386 Sink/basin/lavatory 25.02
CityiState/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54 I
Phone: (503) 692 -5945 I Fax:: (503 -) 692 -0768 Tub/shower/shower pan 12.51 .
E -mail: a lenen Iandscapeoregon.com Urinal 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
Phone: (503) 692 -5945 Fax: (503) 692 -0768 Minimum permit fee: 572.5 72.50 I
CCB Lie.: LCB 7804 . Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fee) S.70
Authorized �:tIar / ) ' e -�Ll TOTAL PERMIT FEE 91.20
Print name: Ellen Sparrow Date: ' T1tu permit application expire-cif a permit b not obtained Within ISO days
I l if 0_1_ after It has been accepted as complete.
`Fee mettodolotry set by'. ri-County Building Industry Service Board.
I : \nce7dms'Pmoitr,PLMti -Pe tApp.dre 1D01.99 440- 416T(10iY2COi`4.WEN)
1 ' d 89L0 Z69 - 009 uell3 dLO:CO Zl 91, noN