Permit (41) CITY OF TIGARD
' COMMUNITY DEVELOPMENT PLUMBING PERMIT
:IIn Permit#: PLM2016-00121
Date Issued: 06/20/2016
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S109DB07100
Jurisdiction: Tigard
Site address: 13111 SW KOSTEL LN
Project: Summit Ridge NO.5,Lot 139 Subdivision: SUMMIT RIDGE NO.5 Lot: 139
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 97239
PHONE: 503-631-3893 PHONE: 503-222-4151
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/20/2016 $31.27
Specifics: 1 12%State Surcharge- 06/20/2016 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 06/20/2016 $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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 6........_ Permittee Signature: j�
rj
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 Application
- Building Fixtures
City of Tigard *'Ci ®� Received3 �,0 1,�
• 13125 SW Hall Blvd.,Tigard.OR 97223 ,too �0 DateBy: /� ��"f �r �-s'CE's 1 41
Plan Review
IN • Phone 503.718.2439 Fax: 503.598.1960 Date Be: Other Permit No.:
Inspection Line: 503.639.4175 ,./,,:9, '�%
1 1 ti A it DDate Reader By jr-,.,...oris: 65 See Page 2 for
svv
Internet: wtigard-or.gov \otified/Method: .. Supplemental Information
TYPE OF WORK L FEE* SCHEDULE
14 New construction ❑Demoliti5V For special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
el 1-and 2-family dwelling 0 Commercial industrial SFR(2)bath 437.78
0 Accesson building 0 Multi-famil SFR(3)bath 5p°32
Each additional bathkitchen 25.02
0 Master builder 0 Other:
Fire sprinkler(_sq.ft-I Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _
Job site address: \'-I 1 l \I\I V.-C1.70
, Ig, Catch basin or area drain I8.76
`1- �"t w 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.: I Page 2
Storm sewer(no linear ft. _) Page 2
i
Water service(no,linear ft. ) Page 2
1
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backtlow preventer 1 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
New SFR Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
• PROPERTY' OWNER i ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer 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: 1 503.i 222-4151 Fax:( ) Ice maker 12.51
0 APPLICANT * CONTACT PERSON lnterceptorigrease trap 25 02
Business name. Medical gas(value:$ i 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 Iavaton 25.02
City/State/ZIP: Portland, OR 97239 Solar units(potable water) 62.54
Phone:(503 )222-4151 x1107 I Fax: :( ) Tub/shower/shower pan 12.51
I
E-mail: esweeks@drhorton.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business nameTrademark Landscapes Inc
p Water pipingDWV 56.29
Address: PO Box 2410 Other: 25.02
City/State/Z_IPOregon City, OR 97045 Subtotal
Phone:(503) 631_38 Fax:(50.31 `/73 7 Minimum permit fee: $72.50
CCB Lic.: 76.1(4.-,..,,,e-•"---' Plan review (25%of permit feel
c. bin L ia.no.:y6ty� _
Authorized signature: el./2State surcharge(12%of permit fee)
TOTAL PERMIT FEE {.(14 c.:2('
Print name: L5f� [//fS I Date:2016 This permit application expires if a permit is not obtained within ISO days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Ser,tce Board.
I Budd:ne PermIs FLAIL-Per^. .A'q cec i!0;)a 440-4616T(I0102iCOMMEBI