Permit CITY OF TIGARD PLUMBING PERMIT
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a COMMUNITY DEVELOPMENT Permit#: PLM2016-00207
T f .�A .t) 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/03/2016
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Parcel: 2S109DB08800
Jurisdiction: Tigard
Site address: 13049 SW BLACK WALNUT ST
Project: Summit Ridge No.5, Lot 156 Subdivision: SUMMIT RIDGE NO.5 Lot: 156
Project Description: Backflow preventer for irrigation
Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC-PORTLAND
PO BOX 2410 4380 SW MACADAM AVE
OREGON CITY, OR 97006 PORTLAND, OR 97239
PHONE: 503-222-4151
PHONE: 503-631-3893
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/02/2016 $31.27
Specifics: 1 12%State Surcharge- 05/02/2016 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 05/02/2016 $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: 6. /1 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 ADDIic C :, /ED
Building Fixtures
City of Tigard APR 4 2016 Received
13125 SW HaII Blvd.,Tigard.OR 97223 �auBy, y JS �� (------ .413
` pC1Ait*o.: Ll��/6�ODp��
IN
Phone: 503.718.2439 Fax: S Plan Reviewy�
Inspection Line: 503.639.417 Tl�� DatetBy: Other Permit No.: j75T�/l-er_il�-0
1 1 t,;\1:0 Internet: www'ti d-or. ov b U 1 WING G DIVISION Date Ready.By: Juris a See Pate 2 for
gaz 8 Notified Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
(a New construction 0 Demolition For special information use checklist
Description ( Qty. 1 Ea. 1 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
9 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: (. -)t-1 q C,\) ci),,Ina.„ v`�1 J\y j' Catch basin or area drain 18.76
Tigard, OR 97223 Drywell,leach line,or trench drain 18.76
City/State/ZIP: -
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 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.:,_) Page 2
Storm sewer(no.linear ft.:_J Page 2
Water service(no.linear ft.: Page 2
Subdivision: Lot no.: Iclao 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
$ PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: DR Horton Inc. Fixture/sewer cap 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. Medicalgas
(value:$ ) 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/showerpan 12.51
E-mail: esweeks@drhorton.com Uric 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business nameTrademark Landscapes Inc Water pipingDWV 56.29
Address: PO Box 2410 Other: 25.02
City/State/ZIPOregon City, OR 97045 Subtotal
Phone:(503) 631-3893-�-3 / Fax:(9)3) (0 j/V737 Minimum permit fee: 572.50
��r3a' / me 401(1.3Plan review (25%of permit fee)
CCB Lic.: Plum ' L :
State surcharge(12%of permit fee) 'TTS'
Authorized signature: TOTAL PERMIT FEE 'VE:X-3
name: 4_,E. /7/,s Date:2016 Tis permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Service Board.
I BuildingPermmns'PLMU•Permits.pp.d°c 1001,09 44046161110 D2;COMWEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13049 SW BLACK WALNUT ST, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00207
Don Sylvester
Double check assembly make Febco model 850 ser#HE04565 located front by meter
approved with test results
Violation Summary:
Inspector Contractor