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Permit
i CITY OF TIGARD PLUMBING PERMIT s COMMUNITY DEVELOPMENT Permit #: PLM2011 -00283 1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/08/2011 TIGARD 13125 Parcel: 1S 135CD 10500 Jurisdiction: Tigard Site address: 11685 SW NACIRA PL Project: Abu -Jame Subdivision: NACIRA PARK Lot: 5 Project Description: Irrigation backflow. Contractor: LEWIS LANDSCAPE SERVICES, INC. Owner: ABU -JAME, FARID 6107 SW MURRAY BLVD., #108 11685 SW NACIRA PL BEAVERTON, OR 97007 TIGARD, OR 97223 PHONE: 503 - 524 -3679 PHONE: FAX: 503 - 213 -5921 FEES Quantity Description Date Amount 1 ea Backflow Preventer 09/08/2011 $31.27 Specifics: 1 12% State Surcharge - 09/08/2011 $8.70 Plumbing 41 ea Minimum Fee Adjustment - 09/08/2011 $41.23 Type of Use: SF Plumbing Class of Work: OTR Type of Const: Occupancy Grp: Stories: Total $81.20 l 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: j ' 1 _4 / - Permittee Signature: ©/V p/°L / - 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. Sep 07 11 03:28p Lewis Landscape Services 503 - 213 -5921 p.2 Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard F / �/ .1 �p / _O2f a s Rece 11 s' w�, N� M Dare,By Permit No.' 13125 SW Hall Blvd., Tigard, OR 97223 �, ~' a''' Pla R ev i ew Phone: 503.718.2439 Fax: 503,598'l950 pq Q1 Date,By Other Per No.: TIGARD Inspection Line: 503.639.4 €75 r , Date Ready /By: H See Page 2 for Internet: www.tigardor.gov C,FQ w ^ ;, Notified/Method: Supplemental Information TYPE OF WORK �t „1r" 'rlI'v FEE* SCHEDULE ❑ New construction ❑ Demolitio '''),,C,- ).)" ° , For special information use checklist `" , l , Description I Qty. I Ea. I Total Addition/alteration/replacement Other: 0 ®� ® P ❑ } '' New I- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 ® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder I Q Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 11685 SW Nacira PI Catch basin or area drain 18.76 City /State/ZIP: Tigard, OR 97223 Dtywell, leach line, or trench drain 18.76 Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities . 50.03 Cross street/directions to job site: SW Pihas St 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 It.: ) Page 2 Subdivision: I Lot no -: Fixture or item: Tax map /parcel no.: Backflow preventer I 31.27 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Install backtlow preventer for sprinkler system Dishwasher 25.02 Drinking fountain 25.02 • Ejectors /sump 25.02 Q PROPERTY OWNER [ 0 TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02 Business name: Lewis Landscape Services Medical gas (value: S ) Page 2 Primer 12.51 Contact name: Jim Lewis Roof drain (commercial) 12.51 Address: 6107 SW Murray Boulevard #108 Sink/basin /lavatory 25.02 City/State /ZIP: Beaverton, OR 97008 Solar units (potable water) 62.54 Phone: (503) 524 -3679 Fax: : (503) 213 -5921 Tub /shower/shower pan 12.51 E -mail: ofce @lewislandscape.com Urinal 25.02 Water closet 25.02 CONTRACTOR ' Water heater 37.52 Business name: Lewis Landscape Services Waterpiping/DWV I 56.29 Address: 6107 SW Murray Blvd . Other: ' 25.02 City /State /Z1P: Beaverton, OR 97008 Subtotal 37.21 hone: (503) 524 -3679 Fax: (503) 213 -5921 Minimum permit fee: $72.50 72.50 CB Lic.: LCB# 8112 1 113/// v Plumbing Lie. no.: Plan review (25% of permit fee) / State surcharge (12% of permit fee) 8.7 Authorized signature: TOTAL PERMIT PEE 81.20 1: Print name: Jim Lewis Date: 917/21111 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. 1 :\Building 'Permits.PLNAU- PennitApp,doc ]0,'011) 446- t616T(10/02/COaVw'ED)