Permit CITY OF TIGARD
PLUMBING PERMIT
• COMMUNITY DEVELOPMENT Permit #: PLM2013 -00157
TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/22/2013
Parcel: 2S109DA15800
Jurisdiction: Tigard
• Site address: 15410 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 77 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 77
Project Description: Backflow irrigation device.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES
PO BOX 2386 4230 GALEWOOD ST., SUITE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 692 -5945 PHONE: 503 - 387 -7577
FAX: 503 -692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/22/2013 $31.27
Specifics: 1 12% State Surcharge - 05/22/2013 $8:70
Plumbing •
Type of Use SF 41 ea Minimum Fee Adjustment - 05/22/2013 $41.23
Class of Work: OTR
Plumbing
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: ////��� � Permlttee Signature:
e.-"5 Ai
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 ppUea io t RECEIVED
BU1l(Iine Fixtures I FOR OFFICE USE ONL •
MAY 2 2013
City of Tigard pate ey� d �IIr` Potmit No� o?0 /i t%' /�7
j ig a 131_'5 SW Hall Blvd.. TiEa d OR 97223CITY OFTIGARD pin Review ..
C . Phone: 503.718 2439 Fax: 503.59I�PLDING DIVISIO DateBy: Other Permit v r aZO /3 - 0 0 076
TIGARD t o petition Line: 503.635.4175 Date Ready /Hy I brit E7 See Paget for
cmne� xwvr.tieard- or.gcv *totified)Methcd.: Supplemental
:. , . . . _ .. rrPS: of wortx .. _ = - -' - - - = Fit aFA��: = ` , - "- - -
® New construction [:1 Demoi:tion For special information use checklist J
, Description I Qty. 1 Ea i Total '
E Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft_ for each utility connection)
Ol\rSTI2 1, _ ;! .` SFR (1) bath 312.70
.. C
® 1- and 2- family dwelling ❑ Commercial/ ndustrial SFR (2) bath 437.78
Accessory building FR (31 bath 500.32
Acc
g • ❑ Multi- fatn::y
Each additional bath/Idtchen 25.02 `
C Master
builder ❑ Other: 'Fire sprinkler ( sq. ft.) I Page 2 I
:;';�! ' _ '` �JOS :SITE'ENFORMATTO ,kN LOCATIoI !'I' = I Site utilities:
' R
Catch basin or area drain I 18.76
Job site address: / 5
/ S- LL,- ,M't,,'cl,t',cc , !.� D
City/State/ZIP: i StattJL.IP _ tywell, leach line, or trench drain , 18.76
r5' T 1 l-c_ L:t_ G' ►Z `/ 7 'D' g 2
�� Footing drain (no. liner ft.: ) Page ..
Sutebldg.lapt. no.: Project name: 1 - 1 i rl ei /71-1 )jj., € /•,,/ t - /)l<y:v1anufaetured home utilities 50.03
Cross street /directions to job site: (( Manholes 18.76
S-( t) b c t !- i' 1,:_.` , .-- Raindtaincennector 18.76
.1-•( .I 5'"1'1 Vl'1��% r C.__■
D r Sanitary sewer (no. linear ft.: _ ) Page 2
Stoma sewer (no. linear ft.: ) Page 2 I
Water service (no. ling ft.: ) I Page 2 I
Subdivision: i o no.:
Rif 1 I ; � � L YE � � "� � Lt 7� F ixtttreoritem: i
-
Tax mapiparce_ no.: ( . 5 ,4' Bacldlow preveater I x 3..27 31.27
` !, 'I - ' .
' R C id . - ∎ : .. :
!, ,;_ ` ECRIPTION O : W O! ;:r . ..! ', :, ; =
i: i'ar` , ii , ,, jai
S :_.., WORK! i!.: ; =r Backwater valve 12.51
, Clothes washer 25.02
Landscape Irrigation Back Flow Device i Dishwasher 25.02
Drinking fountain 25.C2
Ejectors/sump 25.02
l; i _ ? , 'i PROPFRT _OWNER? , i 'l i !': 0- `IEIYAty' -r Expansian tank I 12,5]
Name: Scone Bridge Homes NW LLC
Fixture /sewer cap I 25.02
Floor drainifloor sink/hub 25.02
Address: 4230 Galevvood Street Suite 100
Garbage disposal . 25.02
City /State/ZIP: Lake Oswego, OR 97035 Bose bib • 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
'iki ; : t1-,- ;a:., ; ;.' -, :i X 7 : 4 :,. ; :.iii. Interceptor/grease tra 25.02
-
! ! L . [
® APP -: , _ ' ., - , ILCT : i trap
Business name: Landscape Oregon, Inc Medical gas (value: S ) Page 2
Contact name: Ellen Sparrow Primer 12,51
Roof drain (commercial) 12.51
Address: P.O. Box 2386 Sinldbasin/lavatory 25.02
i.
City /State ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax:: (503 -) 692 -0768 I , Tub /showerishower pan 12.51 1
E - mail: ellen@landscapeoregon.com ! urinal 25.02
. ;:: r Vl amen closet 25.02
::1.: -- _ -4[i 'CONTRACTOR; . €.!,^i.T _
"' - " "` _' '" ' ' " :::'!'.'-1::::':':1.'4'.!,:',':::::' watcr heater 37.52
• Business name: Landscape Oregon, Inc. Wat_rpiping/ptiti 56.29
-Address: P.O. Box 2386 Othe-: I 25.02
City /State/ZIP: Tualatin, OR 97062 Subtotal 31.27
hone: (503) 692 -5945 I Fax: (503) 692-0768 MEiimtun permit fee: 572.50 72.50
/ 1 Plan review (25% of permit foe)
CCB Lie..: LCB 7804 / i Plumbing Lic. no.: State surcharge ( :2% of permit fee) 8.7C
.Authorized signature - -L - �' �� /1�(i2e.t_ TOTAL PERMIT FEE I 81.20 I/
Print name: Ellen Sparrow I Date: e I This permit application expires.if a permit is not obta ned within 180 dabs
1 / �/�I• after it has been accepted as complete.
Fee methodology sat by Tri- County Building Industry Service Board.
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