Permit CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit#: PLM2013-00381
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2013
Parcel: 2S110CB10100
Jurisdiction: Tigard
Site address: 15382 SW ARLINGTON TER
Project: Arlington Heights No.3,Lot 89 Subdivision: ARLINGTON HEIGHTS NO.3 Lot: 89
Project Description: New SF
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 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: c
�%
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 ApplicationREi CEIVED
• Building Fixtures
City of Tigard OCT 2 3 2013 Re ee
II
n 13125 SW Hall Blvd.,Tigard,OR 97223 Datenk; it]I 13 07?-- Permit No.:jL�Roil l_0Q,r/
R Phone: 501718.2439 Fax: 503598.�q�� Y _
Plea Review
(l1
Iaapccdon Line: 703.639.4175 \ 1 l O1 I 1 LlR D Daa1By: Otbor Permit No.:/v1 T L' _�,r/ r l
f I i;,1 K 11 to Ready/By kris: See Page 2 for
1
Internet: aww.tigani-or.gov
TYPE OF woBIUILDIN�= nmVISIOV o6i5ed/Method; 'j'qf, suppiemenraiinformadon
FEE* SCHEDULE
®New construction ❑DemoIition For special information use checklist
❑ Addition/alteration/replacernent Description I Qty, Ea. Total
• ❑Otha' New 1.2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® I-and 2-family dwelling ❑ Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other Fire sprinkler
JOB SITE INFORMATION AND_LgC Ia; ut ( sq.ft.) Page 2
l��r iY Site utilities:
Job site address: / C3 k s tL --_ . • �� -. - Catch basis or area drain 18.76
City/State/zlP: 'Ti r i L et (-,!\ C�-I a- 3 Ihywell,leach line,or trench drain 18.76
SuitePo(dgJapt no.: Project name: r Footing drain(no.linear ft.: ) Page 2
II in(I '),) '9 Manufactured home utilities
___Cross street/directions to job site: 50.03
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft: ) Page 2
Storm sewer(no.linear ft.:_ ) 1 Page 2
Subdivision: ' /i, Water service(no.linear ft.: ) Page 2
fen kle-cc1LAS I Lctno.:el Fixture or Item:
Tax map/parcel no.: Backflow preveater x
31.27 31.27 .
DESCRIPTION OF WORK Backwater valve 12.51
Landscape Irrigation Back Flow Device Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I Q TENANT Expansion tank
12.51
Name:Stone Bridge Homes NW LLC Fixttrralitewereap 25.02
Address:4230 Galewood Street Suite 100 Floor drain/floor sink/hub 25.02
City/State/ZIP:Lake Oswego, image disposal 25.02
ego,OR 97035
Phone:( ) e b� 25.02
I Fax:( ) _
® APPLICANT
Ice maker
12.51
® CONTACT PERSON Interceptor/grease trap 25.02
Business name:Landscape Oregon,Inc. Medical gas(value:$,) Page 2
Contact name:Ellen Sparrow Primer I2.51
Address:P.O.Box 2386 Roof drain(commeteial) 12.51
City/State/al):Tualatin,OR 97062 Si asi vatory 25.02
Solar units(potable water) 62.54
. ?bone:(503)692-5945 I Fax::(503-)692-0768 Tub/shower/shower pan
12.51
Urinal 25.02 elen glandsca e ore g on men
CONTRACTOR Water closet 25.02
Business name:Landscape Oregon,Inc. Water heater 37.52
Address:P.O.Box 2386 Water p1PlDWV 56.29
Other 25.02
City/State/Zip:Tualatin,OR 97062
Subtotal 31.27
Phone:(503)692-5945 Fax:(503)692-0768
. Minimum permit fee: $72.50 72.50
CCB Lic.:LCB 7804 _ Plumbing Lic.no.: Plan review(25%of permit fee)
Authorized signature;.. State surcharge(12%of permit fee) 8.70
' `/')._,.. ..-//'
i <<"A/L` -✓ TOTAL PERMIT PEE 81.20.L
Print name:Ellen Sparrow I Date:,•' ' ` T3` This permit a
Jj .,3 j :,i ,,� ppllcatioa etcpires,if a permit is not obtained minim 180 days
f after it hsa been accepted ne Complete,
`Fee methodology set by Tri.County Building Industry Service Board,
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