Permit q CITY OF TI`7AR® EMBED PLUMBING PERMIT
I N 3 :'-< COMMUNITY DEVELOPMENT 3 (0"/ 3 srl Permit #: PLM2013 00066
_T i G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/25/2013
Parcel: 2S109DA16500
Jurisdiction: Tigard
Site address: 15306 SW OAKMONT PL
Project: Arlington Heights No. 3, Lot 84 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 84
Project Description: (1) backflow device for landscape irrigation 3/6/13 REPRINT permit to correct description
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW
PO BOX 2386 4230 GALEWOOD ST, SUITE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
P
PHONE: 503 - 387 -7577
HONE: 503 - 692 -5945
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/25/2013 $31.27
Specifics: 1 12% State Surcharge - 02/25/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 02/25/2013 $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 , , n tii A k t Permittee Signature: o' ` A pp, 7--/vkl
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 RECEIVE
•
Building Fixtures FOR OFFICE USE ONLY
City of Tigard FEB 2 5 2013 Receive
Permit 1:o.:
a 131 SW Hall Blvd., Ti trd, Ok 97� %% 't+v T►r� L DatrBy; �S 13 S f`L/i aZl� /3 -coo ( y
Phone: 503.',182439 Fax: 503.598.1 1 1 OF i ilj pp�� I Plan Review' s'
t1ilL Ot her Permit No.: bO� /
lnspe:tion Lire: 503.6 ?9.•1115 1] a l e. 'R y: It�l S/ e �� eZ- �[-
TI cARn BUILDING El
Internet: www.ugard -cr.gov Page: for
:: :!'F °i•_• _ -, , .s :.. ��r - - -: .. _ _ _ _ _ _ _ _ _ Supple men NI Embrmanon
1) tt R°aC !�
Tvatifiellllethod•
• .... ....,; Ti I:.... .a ::,_. CIS _ .: . _ -' `., - --
® New construction : _. - :
❑ Demoliti For speci inform use checklist
Description 1 Qry. i Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwcllinPs (includes 100 ft_ for each utility connection)
®®` i i t i GA,IEG617V: f e ifcrioti r.' 3, ` IV I SFR (1) bath I 312.70
El 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath I 437.78
❑ Accessory building ❑ Multi- family I SFR (3) bath 50032
Master builder Each additions
w::' -.r,., ,- : I'. .9: ., ❑ 'Firsprinkler(l bath/kitchen .02 sq.fL)
. .ys°:_::,,�- •- sa.. ;::m,- :: ° ;� °' ... _ _ Other - •a�.,__sr: - -
0�1TI .
•. - •�•�.••........• 1T!'C514== .414FIL; - �7wi�ra,r� ::i:� ; " _ I
,. Dios: °.:,n .e d: � i,..� �r-r. .�., _
_�:. -- T..__._,..:..,�.,,....,,. -.._. �,,�.--- -s_. !1_;:�iw� Site utilities!
Job site address 15 C: 0., (1 r�k 1)1 :�.- - Catch basin or arm drain i 18.76
i P/c er. II
City/Stale/ZIP: •77 f e.clit., CAL e n .D-0 Dryu'cll, leach link or trench drain 18.76
Footing drain (no. linear ft.: � Page 2 '- 18.76
Suite'bld ;)apt. no.: roiect name~ )/�' l C� ] - - g / Manufactured home utilities 50
Cross street/directions to job site; P
Rio , ( Manholes
QCiCf /crtct , Rio SLLi"YUri-t-i1, D --3 Rain drain connector • 18.76
(2-LC/ 11 6 (' 1 •-/C -C 1- GZ4.-,1' Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) I Page 2
' Water service (no. linear ft.: ) I Page 2 1
Subdivision: AY/ / i C - j fen _ c j2 Lot r.o.: � Fixture or item:
B
Tax map/parcel no.: £ C a kllow preventer 1.17 31.27
a r, -- ,,,.,...�..-
,i;, ErL•nd °9' 'r_dt�:ei _ _f =_ __ W€r:_:`ae_ _ -��_ - st '9.5 =: i.��y, = Backwater valve 12.5' •
Landscape Irrigation Back Flow Device Clothes wash l 25.02
Dishwasher I 25.02
Drinking fountain I 25.02
Ejectorsisump 25.02 1
iiK11:ii00#1 F +�' 1 10 40C.' 'l ii;'i: .i.d =P ii _ -- ` 'T„° .'ieili Ald rf
. .., 4,.� „- ,_ _:E W.,- �.�, =. o R`- ::.,.., - -,� -' � _ _: QF3 E:tl1 A'Nf r ' s l -- tutsioa tank 2
�,_.m...._.1.M ; . .., ,, ii�s215 ;�e� - _ - . . _,_.. _,.s:,'x+d�!'_fn�'�� Exp 1 ,51
Name: Stone Bridge Homes NW LLC Fixturelsewercap 25.C2
Address: 4230 Galewood Street Suite 7.00 Floor drain/floor sicLhub - 25
Garbage disposal . 25.02
City/State/ZIP: Lake Oswego, OR 97035 Hose bib 2502
Phone: ( ) 1 Fax: ( ) Ice maker 12.51
' P -� 1 "SN�}'1:�SY �. ' 'H.. _ _ , - .i,'a T - °_ _- - - 9
. ,'�:`,t _ ; 5 :f `:' „AP,P.Liii tF 1. ':: r i r:a. _ ,11 =�;: lntn coo wd
g'_ .i1E,11t -.i.. : -. = „a ,,,C_.{� ; '_.. it:ii "�p. e,i -_.i :• tap 25.0
-:�,. ��� . ?!_� ;�:: li't ]rI+7[?� F'� .,
r"'`i ease ra �
.C,
Business name: Landscape Oregon, Inc Medical gas (value: 3 ) page 2 '
Contact name: Ellen Sparrow Primer 1251
Roof drain (commercial) 1251
Address: P.O. Box 2386
Sink/basin/lavatory
25.02
City /Stet&ZI?: Tualatin, OR 97062
Solar units (potable water) 6254
Phone: (503) 692 -5945 Far.:: (503 -) 692 -0768 Tub /shower/showerpan I 12.51
E -mail: ellen@landscepeoreaon.com Urinal 25.02
G: .,.- ',l i e:. :.6._._: ._ __ __ s.-" ' : -_- Watereloset 2 5.02
2 9a� `e•: rS.% 4i .:, - ^ r,. - i - - -- ltvr ;�_e'= - i
'IEw ;lam -'a1�5�� c�.; §:. s ~. :.. �.._ . c a--.. _ . - n . £ ya_ .. - =_��e ��s�.. �,_ • � �
waled? I 37.52
• Business name: Landscape Oregon, Inc.
Water piping/DWV 56.29
Address: P.O. Box 2386 I o I I 25.02
City/Stare/ZIP: Tualatin, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax: (503) 692 -0768 I I Minimum pe:mir fee: 372.50 ;2.50
CCB L:c.: LCB 7804 Plumbing Lie. no.: Plan review (25% of permit fee)
State surcharge (12% ofpermmit fee) i 8.70
Authorized signature :‘ i ? �j�1 4 -LC 7Z�-% TOTAL PERMIT FEE 81.20
Print name: Ellen Sparrow �/ 1 Da p-r - O••� LJ /; r l
" This permit application exptres.if a permit is not obtained nithla 180 days
/ p I/f after It has been accepted as complete.
*Fee medIodulupy set by TO-Canary Building industy Service Board.
1:1Buudi .Pe:mi :s1PLMU- PczitApI,dce 10'01,09 440 -16 I6T(2 DA:C1COMTWEB)
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