Permit a CITY OF TIGARD PLUMBING PERMIT
11 4 COMMUNITY DEVELOPMENT Permit #: PLM2013 00129
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/23/2013
Parcel: 2S109DA16700
Jurisdiction: Tigard
Site address: 15477 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 96 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 96
Project Description: (1) backflow device for new SF
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 04/23/2013 $31.27
Specifics: 1 12% State Surcharge - 04/23/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 04/23/2013 $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. /� n
Issued By: F J J4OI( r q , t n 0 t Permittee Signature: � A PPLI c4 nag
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 AncllicananREcEiVE p
Building Fixtures FOR OFFICE USE ONLY
APR 2 3 2013 k ceivec
City of Tigard 4 a 3! 3 sr Permit No : et 3- ,, e-7
Da,eB !
=
n ?h ?hone: SW Hal] .2459 Ti Fa W3 9722 TY OF TIGARD � - la n Review �'
none: >03.718w439 Fax: 503.59E I Date!By: Other Permit No.1 ejl�a3 -to t ' !
TI C, ^.F.L_) Inspection Line- 5C3 63,4.4)75 t DtVi5tOp,p: DaleRe20yrBy, 4 ®
_nteme: avw w.tigard- or.gov V�rVV I Notified/Method: S5llnformatian
- , TYPE OF �'O}2h :. ' '. ' ''E'': SCSEDULE •
:`t era. u „ .: _ . . .... � .:.: FE ......... , ::
Demolition For s or rio a ore checklist constru_t,on ❑ P f
Description I Qty I Er. 1 Total
] Addition/alteration/replacement ; ❑ Other. New I- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR ] bath I 312:70
® I- and 2- family dwelling I 0 Commercial /industrial SFR 2) bath 437.78
❑ Accessory building SFR (3) bath 500.32 '
❑ Mu1 : :- family
Each additional bath/kitchen 25.02 ,
L' Master builder I ❑ Other: 'Fire sprinkler ( sq. ft.) Page 2
t,# - AN'D.LOeATlON; -
JOB SITE INFORMATION Site utilities:
1 Job site address: 1 5 Lf '7 t_i_iT) n.lciii i e-C,L) D. Catch basin or area stain 1 fi.76
City /StatefZf. *7 1.11,uj_ C A 5 7 . ?' , 9 t y
Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: _) Page 2 I
( /
Suiteib1dg. /apt. nu.: f Project name: ii it t ;! f?2 Y7 '7 (L Manufactured home utilities 50.03 1
Cross st eet/ di rections to job site: J Manholes 18.76
-W al /dx °
J C •)4 /Z Litt. p . Rain drain connector 18 -76 _
Sanitary sewer (no. linear ft.: „_) Page 2
Storm sewer (no. linear ft.: _) Page 2
�/L� Water service (no. linear ft.:.._._) Page 2
Subdivision: rn J ■ l •�p f t r t ..j - i Lot no.: 5 Fixture or item:
Tax mapiparccl no.: (p / � S 4 7 v Baeldlaw preventcr x 312^ 31.27
, Ba kuater valve 12.51
- Ill DES ON'OF WORI'<
Clothes masher 25.02 ,
Landscape Irrigation Back Flow Device
Dishwasher 25.02
Drinking fountain 25.02
Ejectotslstmtp , I 25.02
❑' TE?ANT Expansion tank 12.51
1 r 2i � tOEPRTf • O V4'\ER : : -
Name: Stone Bridge Homes NW LLC Fixture/sewer cap 25.02
Floordrainrfloor sinkrhub 25.02
• Address: 4230 Galewood Street Suite 100
Garbage cisposal 25.2
City/State/ZIP: Lake Oswego, OR 97035 1 Hose bib 2 5.02
Phone: ( ) Fax: ( ) Ice make- 12.51
F a *- } � etceator/grease trap 1)$.141 •- :.® AP.PLICAAT. CONT�: i . :. - . Fit 1:1,".
t P 2502
Business name: Landscape Oregon, Inc. Medical gas (value: 5__ _) Page 2
- Primer 12.5I
Contact name: Ellen Sparrow
Roof drain (commercial) 12.51
Address: P.O. Box 2386 Sink/basin/lavatory 25.02 1
CityiState : Tualatin, OR 9 I Solar units (potable water) I 1 6234
Phone: (503) 692 -5945 Fax: : (503 -) 692 -0768 Tubtshowerishower pan 12.51
E- t:oa`I: ellen@landscapeoregon.com Urinal 25.02 • a `, is . CONTRACTOR : : : it ,( Water er s ea heater 2
P.ra Water h t 37.52
Business name: Landscape Oregon, Inc. Water piping DV V 56.29 '
Address: P.O. Box 2386 Other. 25.02
City/State/DP: Tualatin, OR 97062 • Subtotal i 31.27
Phone (503) 692 -5945 Fax: (503) 692 -0768 Minimum perm It fee: 572.50 '2.50
CCB Li c.: LCB 7804 Plumbing Lie. no.: Plan review (25% of permit fee)
• State surcharge (12% of permit fee) 8.7C
Authorized si a;ure:
8n l.�/F/LL' TOTAL PERMIT FEE 8 1.20
Print name: Ellen Sparrow Date: � permit application epires.if a permit Is not obtained within 1B(I days
1 3 after it bas been accepted as complete.
^Fee :netbodology set by -ri -County Building Industry Ser. ice Board.
t:\ A' rtldiac'PermiolPLML- Pcmur.e 10)1.'09 i o - ieltT(Io,e,cOM/we)
I.•d 89LO Z69 - £09 Uell3 6 S£ 1 80 £l £Z add
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15477 SW SUMMERVIEW DR, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
06/04/2013 00:00
PLM2013-00129
FAIL
Not ready for inspection. No inspection made OPSC 103.5.1
Recall
Violation Summary:
Inspector Contractor