Permit (3) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT
Permit*: SWR2016-00092
Date Issued: 04/12/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S109DB08700
Jurisdiction: Tigard
Site address: 13061 SW BLACK WALNUT ST
Project: Summit Ridge No.5,Lot 155 Subdivision: SUMMIT RIDGE NO.5 Lot: 155
Project Description: Sewer connection for new SF
Contractor: Owner: DR HORTON INC
4380 SW MACADAM AVE
PORTLAND, OR 97239
PHONE:
PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/06/2016 $5,100.00
Sewer Inspection-Residential 04/06/2016 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,135.00
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 503.2 1987 or 1.800.332.2344. ,, /
Issued By: /�—' Permittee Signature:Ae ,0/1/ liiG/eP�j'�d'�O
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.
q CITY OF TIGARD PLUMBING PERMIT
1111
I COMMUNITY DEVELOPMENT Permit#: PLM2016-00148
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/12/2016
Parcel: 2S109DB08700
Jurisdiction: Tigard
Site address: 13061 SW BLACK WALNUT ST
Project: Summit Ridge No.5,Lot 155 Subdivision: SUMMIT RIDGE NO.5 Lot: 155
Project Description: Irrigation backflow for new SF
Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC
PO BOX 2410 4380 SW MACADAM AVE
OREGON CITY, OR 97006 PORTLAND, OR 97239
PHONE: 503-631-3893 PHONE:
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/06/2016 $31.27
Specifics: 1 12%State Surcharge- 04/06/2016 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 04/06/2016 $41.23
Type of Use: SF 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: /1/-‘179°4/69-7-70A i
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 ApplicatioRECEIVED
Building Fixtures MAR 16 2016 I OR (II I It I i Ni O\i 1
City of Tigard Received, 3/j��j� Permit No.:0 A0/b-a7/2/�
11 11 13125 SW Hall Blvd.,Tigard,OR 972 Y OF TIGARD
ran Review
Phone: 503.718.2439 Fax: 503.511 t Other Permit No
,11:57p6/6
1 \i P Inspection Line: 503.639.4175 C3 DING [7iVISiQ Date R ey ,w� B f'f /�j DO//y
See Past 2 for
Internet: www.tigard-or.gov NotifedrMeteod: Suppkmental information
TYPE OF WORK FEE* SCHEDULE
(i New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
e 1-and 2-family dwelling 0 Commercial/industrial SFR(2)batt' 437.78
buildingSFR(3)bath 500.32
0 Accessory . 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
i tD(� ` V, Z( „ „�� Catch basin or area drain 18.76
Job site address: l `�K.� j�[�lI 1� �"
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard, OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: Summit Ridge Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:J Page 2
Storm sewer(no.linear ft.:_J Page 2
�� Water service(no.linear ft.: Page 2
Subdivision: l Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
New SFR Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
ip PROPERTY OWNER ( 0 TENANT Expansion tank 12.51
Fixture/sewer
Name: DR Horton Inc. 25.02
Floor drain/floor sink/hub 25.02
Address:4380 SW Macadam Ave Suite 100 Garbage disposal 25.02
City/State/ZIP: Portland,OR 97239 Hose bib 25.02
Phone:(503) 222-4151 Fax:( ) Ice maker 12.51
0 APPLICANT •CONTACT PERSON Interceptor/grease trap 25.02
Business name: DR Horton Inc. Medical (value:S ) Page 2
Primer 12.51
Contact name:Emerald Weeks
Roof drain(commercial) 12.51
Address:4380 SW Macadam Ave Suite 100 Sink/basin/lavatory 25,02
City/State/ZIP: Portland,OR 97239 Solar units
(potable water) 62.54
Phone:(503 )222-4151 x1107 Fax::( ) Tub/shower/shower pan 12.51
E-mail: esweeks@drhorton.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business nameTrademark Landscapes Inc
P Water piping/DWV 56.29
Address: PO Box 2410 Other: 25.02
City/State/ZIPOregon City, OR 97045 Subtotal
Phone:(503) 631-3893 Fax:( ) G3/-V 73 7 Minimum permit fee: $72.50
CCB Lic.: --7 pp Plan review (25%of permit fee)
j! r � / 6 Plumip. ta.:rn6 6o�2Qdi
7 / State surcharge(12%of permit fee)
Authorized signature: 4/ TOTAL PERMIT FEE
LPrim name: L5 L 1//,.s Date:2016 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as compkte.
•Fee methodology set by Tri-County Building Industry Service Board.
I':Building,PermitsPLMU-PerntitApp.doc 10,0109 440-4616T(1002/COM:WEB)