Permit CITY OF TIGARD PLUMBING PERMIT
lig.-
a ., COMMUNITY DEVELOPMENT Permit#: PLM2016-00155
T f G.'\R.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/20/2016
Parcel: 2S109DB07000
Jurisdiction: Tigard
Site address: 13125 SW KOSTEL LN
Project: Summit Ridge No.5,Lot 138 Subdivision: SUMMIT RIDGE NO.5 Lot: 138
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 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 obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
'.7Issued By: Permittee Signature: e -� �;
C 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 ApplicationECEIVED
Building Fixtures �[ 1O1t Oil 1t 1 1 'Nl t)v1 1
City of Tigard MAR 2 3 2016 Oa /OL�Ja2D 7Z/
3 2S/ ��1. Permit o /6
III � 13125 SW Hall Blvd.,Tigard,OR 97223 P�� 6
Phone: 503.718.2439 Fax: 503.598.y9f�y OF TIGARD • I al/69�„SAoi -.ear26
Inspection Line: 503.639.4175 v� Date By' Other Permit
1 IU;\Kt) gaz g BUILDING DIVISION"R�/BY, Jam' SeePate2for
Internet: wKw.ti d-or. ov NotifedAlethod: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
L.New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. ] 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
PI t-and 2-family dwelling 0 Commercial/industrial SFR(2) ' 437.78
Accesso buildin SFR(3)bath 500.32
❑ >T g ❑Multifamily
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( ,sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 131 ZS S K0 q_eil
Lo ,^ nw Catch basin or area drain 18.76
lJ� 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.: ) Page 2
Water service(no.linear ft.: Page 2
Subdivision: I Lot no.:1V.)._ 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 1 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
City/State/ZIP: Portland,OR 97239 Hostage disposal 25.02
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 gas(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/shower pan 12.51
E-mail: esweeks@drhorton.com Urinal 25.02
Water closet 25.02
CONTRACTOR
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:( 3) 6,3/-5/73 7 Minimum permit fee: $72.50
.!69'79 /-- Plum Stoi:me,4 6a permitfee)CCB Lic.: ��',/, Plan review (25%of
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: L5eJ L [//jS Date:2016 This 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 ButIding:Permns•PLMtJ-PemntApp.doc 10,0109 440.4616T(10/022COStWEB1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13125 SW KOSTEL LN, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2016-00155
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
1 " Febco backflow assembly model 850 ser#HE20540 located behind meter at side walk
approved with test report.
Violation Summary:
Inspector Contractor