Permit •
If CITY OF TIGARD PLUMBING PERMIT
! 2 • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00253
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/23/2013
Parcel: 2S109DA15900
Jurisdiction: Tigard
Site address: 15432 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 78 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 78
Project Description: Irrigation backflow device.
Contractor: LANDSCAPE OREGON, INC. Owner: STONE BRIDGE HOMES NW LLC
PO BOX 2386 4230 GALEWOOD ST, STE 100
TUALATIN, OR 97062 LAKE OSWEGO, OR 97035
PHONE: 503 - 692 -5945 PHONE:
FAX: 503 -692 -0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/23/2013 $31.27
Specifics: 1 12% State Surcharge - 07/23/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 07/23/2013 $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.
Issued By: Permittee Signature: ow — e 9-77C?"./ 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 Applica ECEIVED
Building Fixtures JUL 2 2 2013 FOR OFFICE 11SE ONI..l'
/�
��
City of Tigard Received
Date/By; 7/0)3 /3 4r/ p t No fly, 0 / 3 Qoas
• 13125 SW Hall Blvd., Tigard, OR �� TIGARD Plan Review
■ Phone: 503.718.2439 Fax: 503. Other Permit N
BUILD DIVISION
T l r , A R n Date / By: STS /3 �DO6 -
Inspection Line: 503.639.4175 Date Ready /By: PP See Page 2 for
Internet: www,tigand- or.gov Notified:Method: /f � 6 Su lemental information
. , ::: : : _ .... '. TYPE OF WORK' :. , . , '.' .. , _ __ : ' . - .FE E " 5 C'HEDTJLE _ .
® New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. Total
' ❑ Addition/alteration /replacement ❑ Other New t- 2- family dwellings (includes 100 ft. for each utility connection)
.,,..:. CATEGO $K: OF :CONSTLUCTION=.: _, :.''=,� ? ' °_
SFR (1) bath 312.70
® 1- and 2- family dwelling El Commercial/iindustrial SFR (2) bath 437.78
SFR (3) bath 50032
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: 'Fire sprinkler ( sq. ft.) Page 2
' `•: JOB SITE INFORMATION AND' LOCATION Site utilities:
Job site address: r S 1-/3 Ste Lf})rn1t I' (J' 1 c Le 1)1 , - :e drain 18.7E
City/State/ZIP: 7 C C t L(z 0 O. 4 7 7 �a'7' I
/� Footing drain (no. linear ft-: �) Page 2
Suite /bldg. /apt. no.: 1 / Project name/4-0 ei f -,y- t�- / g Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
f 0 p J •__ �, r `in Rain drain connector 18.76
t Sanitary sewer (no. linear ft.: __) Page 2
Storm sewer (no. linear ft.: `) Page 2
' Water service (no. linear ft.: _) Page 2
Subdivision:
AI ' (1 i-9 ( x--71 lli /t Lot no.:7 �7 Fixture or Item:
Tax map /parcel no.: Cc S /...i7 ac o ter x 3127 31.27
valve
Backwater :.._.._ .. ._...._ ..::. -. - - Clothes washer 25.02
Landscape Irrigation Back Flow Device Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
x ;l'RiDI?)LIf> Y O VS NE R , . (. "❑ TENAI'IIT . tank Expansion 12 51
Name: Stone Bridge Homes NW LLC Fixtttre/sewercap 25.02
Floor drain/floor sink/hub 25.02
Address: 4230 Galewood Street Suite 100
Garbage disposal 25'02
City /State/ZIP: Lake Oswego, OR 97035 Hose bib 25.02
Phone: ( ) Fax: maker .
Fax; ( ) 1 malt I2 51 ,
_ - = -` ib;G'f ° PERSO 7 ,, Intereeptot/gr ease trap 25.02
Business name: Landscape Oregon, Inc. Medical gas (value: 3 _ Page 2
Primer • 12.51
Contact name: Ellen Sparrow Roof drain (commercial) 12.51
Address: P.O. Box 2386 Sink/basin/lavatory 25.02
City/State/ZIP: Tualatin, OR 97062 Solar units (potable water) 62.54
Phone: (503) 692 -5945 Fax: : (503 -) 692-0768 Tub/shower /shower pan 12.51
E -mail: ellenJlandscapeoregon.com Urinal 25.02
:
_. -.:..- .._ . :....,... - _.. -.- .,- c set - ; - Water heater 37.52
Business name: Landscape Oregon, Inc. Waterpiping/DWV 56.29
Address: P.O. Boa 2386 Other. 25.02
City/State /ZIP: Tualadn, OR 97062 Subtotal 31.27
Phone: (503) 692 -5945 Fax.: (503) 692 -0768 Minimum permit fee: 372.50 72.50
t i Plan review (25% of permit fee)
( CCB Lic.: LCB 7804 Plumbing Lic. no.: State surcharge (12% of permit fee) 8.70
Authorized signature: ` � 4 t ...k TOTAL PERMIT FEE 1 81.20 ..././
Print name: Ellen Sparrow *yy� This permit application espires.if a permit is not obtained within 180 days
p I Dar j rJ r7! )7 / after it has been accepted as complete.
( 'Fee methodology set by Tri -County Building industry Service Board.
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