Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit #: PLM2013 -00212
Date issued: 06/27/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S 27/201 2300
Jurisdiction: Tigard
Site address: 15495 SW ALDERBROOK CIR
Project: Allen Subdivision: SUMMERFIELD NO.8 Lot: 482
Project Description: Irrigation backflow device.
Contractor: LEWIS LANDSCAPE SERVICES, INC. Owner: ALLEN, RONALD W & CARROL A REV T
6107 SW MURRAY BLVD., #108 15495 SW ALDERBROOK CIR
BEAVERTON, OR 97007 TIGARD, OR 97224
PHONE: 503 - 524 -3679 PHONE:
FAX: 503 - 213 -5921
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 06/27/2013 $31.27
Specifics: 1 12% State Surcharge - 06/27/2013 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 06/27/2013 $41.23
Type of Use: SF 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: 49/1/- 19/7/0z.../ 770"/
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.
06- 26- 13;11:35 ;From: To:5035981960 ;5032135921 # 2/ 2
Plumbing Permit Applicati EcEivED
Site Utilities FOR OFFICE USE O NLY
JUN 2 6 2013 .
t:ci�a
City of Tigard Re Da y : i 00 (I'. • Permit NVOUy c 2e) i3 -QO ,Rj .2_-
13125 SW Hull Blvd., Tigard, OR 97 _ -n/ OF TIGARD Plan Review
': C Phone: 503.718,2439 Fax: 503.5 F��/� n i p Date/By: Other Permit nto.:
T I G A Ii D Inspection Line: 503.639.4175 ING D1� /ISION Ddie Ready /By: Jana H See Page 2 for
Internet: www.tig trd•or.gov Notified/Method: 1 Supplementtd Information
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❑New construction ❑Demolition
For special information use checklist
Description J Qty. I Ea. I Total _
Addition/alteration /replacement ❑ Other: • New 1- 2- family dwellings (includes 100 ft. for each utility connection)
;6fl, ^ -ttiV ':u�:^j.'_d ;+'Y.i 1 Y „Yi 1 ' % "' ',71 f^o ll(E; ',,h n
1- c '' li ' +, . %5i \ , ' , fj i R 7 't'' lY ':i i a 5i t ^ Kg i ii ignt"' SIR (1) bath 312.70
;v''li/, f'a'll ltif(;�i',1:�,;1F'•,�r,Yl9 iti� , . .- % �;:. - ,,;H_`, -,1, {�,,. 1VC�J,�rJ_`!� �'Fl�;,lrcir7 ���- ,r�'��f
0 I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ M ulti- family
Each additional bath/kitchcn 25.02
❑ Master builder ❑ Other: Fire sprinkler (_ - sq. ft.) Page 2
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Job site address: 15495 SW Alderbrook Circle Catch basin or area drain 18.76
Drywcll, leach line. or trench drain 18.76
City /State/ZIP: Tigard, OR 97224
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: 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.: 13ackflow preventer I 31.27
,,,,,:. air ;:;;;d. on.. w' '"r(;.,r,,;,;,,,;, ,,, . ,, , '- •i � /, }- .,,A, +,,..„ . \,, r. ,.., g g Backwater valve 12.51
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Clothes washer 25.02
Install backflow preventer for sprinkler system
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
�:IU,��tP� 1 ` Ida i i;10 /�l''"='.. ,j1i�l!•:;, tf'wi'= V Y'-' p�� iy,,�g.•,' ans n tank 12.51
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Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/Statc/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
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`,, ),,.,;✓., ,� - ;.ylCl''� I e i . � , r +`$e,�; t \:! �,"'' �CO) O a�4.0 r Interco tor/ eau Enip 25.02
Business name: Lewis Landscape Services, Inc, Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: ,Tim Lewis
Roof drain (conuncrcial) 12.51
Address: 6107 SW Murray Blvd, #108 Sink/basin/lavatory 25.02
City/State/ZIP: Beaverton, OR 97008 Solar units (potable water) 62.54
Phone: (503) S243679 Fax: : (503) 213 -5921 Tub /shower /shower pan 12.51
E -mail: office le wislandscupe,com Urinal 25.02
? rv,,,- It i �, �Sf +G. / ,;:5` / y .. . _ . y 1 s { , -0`' i ri ;' +l � i• +„ Wa1Cr closet 25.02
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Business name: Lewis Landscape Services, Inc water pipin8/1)WV 56.29
Address: 6107 SW Murray Blvd. #108 Other: 25,02
City /State /ZIP: Beaverton, OR 970118 Subtotal
Phone: (503) 524 -3679 Fax: (503) 213-5921 Minimum permit fcc: $72.50 72.50
'/ I f P Plan review (2540 of permit fcc)
CCB Lic.: LCB# 8112 3� Plumbing Lic, no.: 9303
1 State surcharge (12% of permit fee) 8.70 /
Authori'zedsi.. jr�� TOTAL PERMIT FEE 81.20 t/
Print name: Jim Lewis Date: 6/26/13 This permit application expires if n permit is not obtained within 180 days
atter it has been accepted as complete.
•Fee methodology set by'I'rl- County Building industry Service 130,.rd.
I :Tull diryWecm.t%T1.MU- tlrm c 10/01/09 440.4e 16T(10/02/COM/Wna)