Permit 44
CITY OF TIGARD PLUMBING PERMIT
11 COMMUNITY DEVELOPMENT Permit#: PLM2016-00133
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/11/2016
TIGARD 9 Parcel: 2S109DB08500
Jurisdiction: Tigard
Site address: 13115 SW BLACK WALNUT ST
Project: Summit Ridge No.5,Lot 153 Subdivision: SUMMIT RIDGE NO.5 Lot: 153
Project Description: Backflow preventer for irrigation
Contractor: TRADEMARK LANDSCAPES INC Owner: DR HORTON INC
PO BOX 2410 4380 SW MACADAM AVE SUITE 100
OREGON CITY, OR 97006 PORTLAND, OR 97035
PHONE: 503-222-4151
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
Type of Use: SF 41 ea Minimum Fee Adjustment- 05/02/2016 $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 obttin a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. (1
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.
PlumbingPermit Application
Building Fixtures
City of Tigard EN ED Received
t atuB,•: q !!P Permit No.: J./4e/6.--60/33
ill I. 13125 SW Hall Blvd.,Tigard Plan Review
Phone: 503.718.2439 Fax: 503.k9,8AK I�60 9 2.016 Date/By: Other Permit No.:
Inspection Line: 503.639.4175
Date Rudy.gy loris M See Page 2 for
mi.. \i:ti� le
Internet: www tigard-or.gov or TIG
AQD Notified/Method: Supplemental Information
TYPE OF �� pIVIS■ION FEE* SCHEDULE
(a New construction BUI i NG±mo ition For s cid in ormation use checklist
-
Description Qty. I Ea. J Total
0 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)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: ,1 115 \),3 Nti kAQ.1Y',111J' 6t. Catch basin or area drain 1 18.76
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.: ( 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.:_J Page 2
Subdivision: Lot no.:l Fixture or item:
Tax map/parcel no.: l t� 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: Fixture/sew•er cap 25.02
DR Horton Inc. 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: Medical gas(value:S ) Page 2
DR Horton Inc.
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 X 1107 Fes::( ) Tub/shower/shower pan 12.51
E-mail: esweeks@drhorton.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name Trademark Landscapes Inc Water piping/DWV 56.29
Address: PO Box 2410 Other: 25.02
City/State/ZlPOregon City, OR 97045 Subtotal
Phone:(503) 631-3893 Fax:(4) 6,3/-4/737 Minimum permit fee: 572.50
f3-.S-� (,?9�� me/?-r)Gaeta Plan review (12%ofpermit fee)
CCB Lic.: ! Plum ' lo-.ro.:
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: J ��/�J Date:2016 This permit application expires if a permit is not obtained within ISO days
after it bas been accepted as complete.
Fee methodology set by Tri-County Building Industry Service Board.
I.Building.Permits'PLMU-PermtApp.doc 10'01,09 4440-4616T(IOD2/COM/WEB1
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
13115 SW BLACK WALNUT ST, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00133
Don Sylvester
1. 1" febco DC, model 850, serial# HE 09615, for irrigation, located at left front corner of
driveway - ok with test.
Violation Summary:
Inspector Contractor