Permit CITY OF TIGARD PLUMBING PERMIT
m COMMUNITY DEVELOPMENT Permit#: PLM2013-00380
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2013
Parcel: 2S109DA16300
Jurisdiction: Tigard
Site address: 15370 SW OAKMONT PL
Project: Arlington Heights No.3,Lot 82 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 82
Project Description: Backflow for irrigation.
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: 503 387-7577
FAX: 503-692-0768
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/28/2013 $31.27
Specifics: 1 12%State Surcharge- 10/28/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 10/28/2013 $41.23
Plumbing
Class of Work: ALT
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:
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>�������"�f
Building Fixtures
OCT 2 3 2013
FOR 01, ICL USE ONLY
City of Tigard Received
a 13125 SW Hall Blvd.,Tigard,OR 97 nate/ey: d 424 l -.(P Permit No.:
III I
,�Y OF TIGARD P[r�2v r 3- ao38D
Phone:SW Hal Blvd. Fax: 503.59 . 0 Plan Review
I ti.AItp 1"'" -lue: 705.039.4177 BUILDING DIVISION o, Ready/By: OtberFnmitNo.: �1�-.lt�l�!in,Internet: www.tigard-or.gov I ® see Paea 2 for /V (�
Notitled/Method: e-, Suppkmeotallnformation
TYPE OF WORK FEE* SCHEDULE
® New construction ❑Demolition For special Information use checklist
❑Addition/alteration/replacement _Description I Qty. 1 Ea. I Total
❑Other: New 1-2-fatuity dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑ Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
❑Master builds ❑Ocher Each additional bath/kitchen 25.02
JOB SITE INFORMATION AND LOCATION Site sprinkler sq.R) Page 2
_Site utilities:
Job site address: �` Catch basin or race drain 18.76 ie,City/State/ZIP: r7� e,. Cc. c Dryweu,leach line,or trench drain 18.76
17 �--} y
Suite/bldg./apt.no.: / I Project name: �y� Footing drain(no.linear R.:_) Page 2
I/r' c/� 6 Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18,76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no,linear ft.:_,) Page 2
Subdivision; L L Water service(no.linear 8.: ) Pa
I l ,.l z'- kT -C; A_;(.1 {Lot no.: e L. Fixture or item: Page 2
Tax map/parcel no.: S S /1,7 Backflow preventer x 3127 31.27 '
DESCRIPTION OF WORK Backwater valve 12.51
Landscape Irrigation Back Flow Device Clothes washer 25.02
Dishwasher 25.02
Dnnldng fountain 25.02
Ejectors/sump 25.02 1
14 PROPERTY OWNER 1 ❑ TENANT' Expansion tank 12.51
Name:Stone Bridge Homes NW LLC Fixture'sewer cap 25.02
Address:4230 Galewood Street Suite 100 Floor drain/floor sink/hub 25.02
City/State/ZIP;Lake Oswego,OR 97035 age disposal 25.02
Phone:( ) Hose bib 25.02
i Fax:( ) _Ice maker
12.51
IT APPLICANT El CONTACT PERSON Interceptor/grease tap 25.02
Business name:Landscape Oregon,Inc Medical gas(value;S�) Page 2 '
Contact name:Ellen Sparrow Primer 12.51
Address:P.O.Box 2386 Roof drain(commercial) 12.51
Sink/basin/lavatory City/State/ZIP:Tualatin,OR 97062 Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
Phone:(503)692-5945 I Fax::(503-)692-0768 Tub/shower/shower pan 12.51
E-mail:ellen @laudscapeoregott.com U> 25.02
CONTRACTOR • Water closet 25.02
Business name:Landscape Oregon,Inc. Water heater 37.52
WatespipinglDWV -
-
Address:P.O.Box 2386 25.02
Other 25.02
City/State/ZIP:Tualatin,OR 97062
Subtotal 3127
Phone:(503)692-5945 Fax:(503)692-0768 . Minimum permit fee: 372.50 72.50
CCB Lic.:LCH 7804 Plumbing Lie.no.: Plan review (25%of permit fee)
Authorized signature .ue� -, State surcharge(12%of permit fee) 8.70 /
L 1 _A-L-CA-7 TOTAL PERMIT FEE 81.20 ✓
Print name:Ellen Sparrow I Date: /C /D.,,/.,, 1 This permit application expires.if a permit Is riot obtained within 180 days
after it has been accepted as complete.
`Fee methodology set by Tri.County Building industry Service Board.
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