Permit v: - CITY OF TIGARD PLUMBING PERMIT
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. ' 2 : COMMUNITY DEVELOPMENT Permit #: PLM2012 00290
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/15/2012
T [ CI AR �' g Parcel: 25111 DC04500
• Jurisdiction: Tigard
Site address: 9440 SW SUMMERFIELD DR
Project: KREMIDAS Subdivision: SUMMERFIELD NO.7 Lot: 360
Project Description: (1) backflow preventer
Contractor: FOREST LANDSCAPE INC Owner: KREMIDAS, TOM
3975 NW SUSBAUER RD 12297 SW CHANDLER DR
CORNELIUS, OR 97113 TIGARD, OR 97224
PHONE: 503 - 648 -8308 PHONE:
FAX:
FEES
Quantity Description Date Amount ,
1 ea Backflow.Preventer 10/15/2012 $31.27
Specifics: • 1 12% State Surcharge - 10/15/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 10/15/2012 $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: Permittee Signature: a, I /1 P ./tri 4 f
/ll �/'f�r N i
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.
Plumbin Permit A Iicatio EcEivE p
Site Utilities FOR OFFICE USE ONLY
City of Tigard OCT eceed /� ( c
O I 0 8 2012 DaleB tt�l' t' sr Permit No.: 1 - D 0a-/c
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13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
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Phone: 503.7182439 Fax: 503.598.] ('� ��{� Date/By: Other Pamit N q ��i�� _ �
Inspection Line: 503.639.4175 �+a TIGARD Rt
TIGARD tvw.ti d -0r. ov d ® Sea Page 2for
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g BUILDING DIVISION Notir,ed/Method: I. IV Supplemental Information
TYPE OF WORK _ . FEE* SCHEDULE
a New construction I Fors information use checklist
❑Demolition special in
P l Description J Qty. I Ea. 1 Total
❑ Addition/alteratiorvreplacement ❑ Other. New I- 2-family dwellings (includes 100 ft. for each utility connection)
•CATEGORY OF CONSTRUCTION • SFR (I) bath 312.70
■ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2
JOE' SITE 'LOCATION
E I INFORMATION - AND Site utilities:
I � --� t -I �\ ,5� (� D
Catch basin or area drain 18.76
Job site address: C 1
Drywcll, leach line, or trench drain 18.76
CiTy /Slate2lP. r-
1 a� t N� U � ZZ y Footing drain (no. linear R: _ J Page 2
Suite /bldg. /apt. no.: �! Project name: ,re rn ckcAs Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear fl.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer ' 31.27 31 Li
. - DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
1 Y\•71 t k l YY iC'�Cx �1
��n ��� S on Dishwasher 25.02
�l Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I ❑ TENANT , Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 1 OY\I \,'((Q, KY\ 1 th
� r . 1 K 1 ;-� Floor drain/floor sink/hub 25.02
Address: � L"-i Lf D <SU) ,c) I y ' r i"-I l r- Garbage disposal 25.02
City /State/ZIP: --1--I c r c 0 q - 7 22 Hose bib 25.02
Phone: ( ) ,.J Fax: ( ) Ice maker 12.51
' • ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
•
Business name: Medical gas (value: $ _ ) Page 2
Primer 12.51
Contact name: y na � j \ Roof drain (commercial) 12.51
Address: `�9 1 \.�h) `X�`i. pr �L `t. Sink/basin/lavatory 25.02
City / State/ZIP: \r • 0 Solar units (potable water) 62.54
Fax: : ( ) Tub /shower /shower pan 12.51
1 1 r • ti
E -mail Urinal 25.02
. Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: �Cw � � \_C r dSa ce. \Y ( Water pipingtDWV 56.29
Address: 1 . i/ Il Other: 25.02
City / State/ZIP: rim y ( 1 C JJ Q ( - 2 //13 Subtotal 3 I .2..1
n Minimum permit fee: $72.50
Phone: ;) 0 L - All Fax: ( )
- Piembill'g Lic. no.:(<C-e -8 Plan review (259'0 of permit fee)
/ State surcharge (12% of permit fee) 8' . 70
Authorized signature: _ .....__A �, J t / 70 1 TOTAL PERMIT FEE
Print name: r Date: _ • This permit application expires if a permit Is not obtained with 80 days
,,. ^. rLy- I nt l ` r • a s - C A 4l a Cl Ci / ~� +a, after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board. y�
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Z 96089179£09 edeospue1)seio j dZ I:ZO Z 1.90100