Permit q CITY OF TIGARD PLUMBING PERMIT
11111 t: COMMUNITY DEVELOPMENT Permit #: PLM2013 00205
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 06/26/2013
Parcel: 2S109DA16000
Jurisdiction: Tigard
Site address: 15446 SW SUMMERVIEW DR
Project: Arlington Heights, Lot 79 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 79
Project Description: Irrigation 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
PHONE 503 - 692 -5945 PHONE 503-387-1511
FAX: 503 - 692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/26/2013 $31 27
Specifics: 1 12% State Surcharge - 06/26/2013 $8 70
Plumbing
Type of Use SF 41 ea Minimum Fee Adjustment - 06/26/2013 $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 ques • -- • 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 Applicatio E E yF
Building Fixtures FOR OFFICE USE ONLY
JUN 2 5 2013
City of Tigard
Received
df - (3 4_- Penm:tN,J �/3 OOo'10 ',
lir Date/
BY S W Hal. Blvd.. T.gard, OR S�/ OF TIGARD Plan Rev ew
Dat 7
513 T. 8 2435 Fax: 523.5 � ®®' fig' e % Other Permit t ST� /3 000
TIGARD
Inspection line 503 539. ,, ING DIVISION nate Reaay,By lath' E See Page : far
Internet: www.rigard -or gov Nottfied.'Metliod: Supplements. information
- - _ L . ' _ - 'T]TE OF WORK: - -. '- -,'• - _ 0 TEE ;SCFHEDLLE' - - .
g New construction ❑ Demolition Forspeeial information use checklist
Descrietien Qry. ! Ea I Total
❑ Addition/altera ' ion 0 Other New 1- 2- fa mily dwellings (includes 100 3 for each utility connection)
_ . " C;I.TEGOR .CONSPRLCTIOPI „ , - ; _ , . SFR ( 1) bath I 31 70
® I- and 2- family dwelling 0 Cornmerc:al /tndustna: SFR (2) bath 437.78
0 Accessory building ❑ Multi- family SFR (3) bath 500.32 1
Each additional bathldtcbem 23.02
0 Master builder ❑ Other:
'Fire sprinkler ( sq. ft.) � � Page 2
_ JOB" SITE ,'INI<ORIMATION 1 , _ Site utilities:
, Joo site address: I sLj' i j 0 ci, t.11)TJ \ i ej e.) D /L - Catch basin or area drain 18 r
I City /State /ZIP: ./ G U, L Uf` 1 7 D -' F ood eli, leach line, or trench drain 1 8.76
J f Footing drain (no. linear ft.: ) • _ Page 2
Suite/bldg. /apt. no.: Project name A-}-1 t , . L3 ' 7 Manufactured home utilities 50.03
Cross street/directions to job site, // Manholes 18 -76
73 •e.. i\ , 1`--o Rain drain connector 14.75
' Sanitary sewer (no linear ft: ) Page 2 I
Storm sewer (no linear ft.: _ ) I Page 2
Water service (no. linear ft.: _ ) J Page 2
Subdivision:
+< L tACI . 11) -- r), 1,-1-e...E.-e t I,t� f Lot no.: `7 �' Fixture or item:
Tax map /Farce: no.: Bacldiow preventer x 31.27 I 31.27
. • = Backwater valve 12 5' . .
,
,., • •
.. - ;' • - ' DESCRIPTION - OF-WORK - - - - 'e'
Clothes washer 25 02
Landscape Irrigation Back Flow Device Dishwasher 25 02
Drinidng fountain 25.02
Ejectors/sump 25.02
E: =PROPE OWN\ ;0 : " y1'' :.:,1 Expansion tank 12.51
Name: Stone Bridge Homes NW LLC Fixnarrlsewercap 25.02
Floor drain/floor sink/hub 25.02
Address: 4230 Galcwood Street Suite 100
Garbage disposal • 25.02
City /State/ZIP. Lake Oswego, OR 97035 Hose bib 25-02
Phone: ( ) Fax: ( ) Ice maker 12.51 1
. ''1• -- - LIE '..AP.I '.1C _' ; TACT' I?ERSON _ Inte ceplor /grease trap 25.02
� C 0
Business name: Landscape Oregon, Inc. Medical gas (value: $ _ ) Page 2
Contact name: Ellen Sparrow
Primer � 12 51
Roof drain. (commercial) I 12.51
Address: P.O. Box 2386
Sink/bssin/lavatcry 25.03
City /State /ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax:: (503 -) 692 -0768 "ub/showcrisho 12.51
E -mail: ellen@landscapeoregon.com Urinal 25 02
- = :_° Water closet 25.02
_•t '
,= _= = `-- ':.:_ = ',5 -- CONTRACTOR'- = -
Water heater 37.52
- Business name: Landscape Oregon, Inc.. HaterpiptngiDthti' 56?9
Address: P.O. Box 2386 Other I 25.02
City / State/ZIP: Tualatin, OR 97062 Subtotal 31.27 ,
Phone.. (503) 692 I Fax: (503) 692 - 0768 Minimum permit fee; 572.50 72.50
Plan review (25% of permit fee)
CCB Lie.: LC13 7804 (� Plunb:ng.ic• no.:
Authorized signature: .Xi a. f1-.C2 State surcharge TOTAL T L ER etmit fee) 8.70 /
/' �-� TOTAL PERhQI?' FEE 8120 t/
Print name: Ellen Sparrow f Jatf' a �l 77 This permit application after expires if a permit is not obtained within 18D da
L 1 i l 3 tt ass been accepted as complete
'Fee methodology set by Tn- County 3uirctng Irdusc- Serv. :e Bond
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£ 89LO Ue113 eZ£ :Ol £I. 5Z unr