Permit CITY OF TIGARD PLUMBING PERMIT
c •• DEVELOPMENT Permit#: PLM2013-00286
Date Issued: 08/19/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 8/19/2 D07002
Jurisdiction: Tigard
Site address: 11340 SW COTTONWOOD LN
Project: Jett Subdivision: ENGLEWOOD NO.3 Lot: 227
Project Description: Irrigation backflow device.
Contractor: LEWIS LANDSCAPE SERVICES, INC. Owner: JETT, STEVEN M
6107 SW MURRAY BLVD.,#108 DUKES, KATHRYN
BEAVERTON, OR 97007 11340 SW COTTONWOOD LN
TIGARD, OR 97223
PHONE: 503-524-3679 PHONE:
FAX: 503-213-5921
FEES
Quantity Description . Date Amount
1 ea Backflow Preventer 08/19/2013 $31.27
Specifics: 1 12%State Surcharge- 08/19/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 08/19/2013 $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: t47/(.77e---- Permittee Signature: <7 7° 4-/e jo
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.
08-14-13; 08:08 ;From: To: 5035981960 ; 5032135921 # 2/ 2
Plumbing Permit Application
Site Utilities RE C IU FOR OFFICE USE ONLY
D Received //I?, -permit No��'/ 2 /3 v(/ �
City of Tigard �ate�ay: , ,7A3 i.
■ 13125 SW Will Blvd.,Tigard,OR 9722 l 1 4 2013 Pl'ut Review
: c Phonc: 503.7182439 Fax: 503.598.19 Daie/By: Other Permit No.:
T t G A R D
Inspection Line: 503.639.4175 CITY OF TI GAR D Date Ready/Ily:
Internet: www.tigard-or.gov Notified/Method: FEE*/;l S CHEDYo J Xs.eEc m:P.nc.: m:2 1,io,r o
matiun
TYPE OF " 141. ING Mt/TUN
. • For special In orm motion use checklist
El New construction ❑Demolition Dcscri,tion Qt . Ea. Total
7 Addition/alteration/replacement ❑Other. I New 1-2-family dwellings(includes 100 ft.for each utili connection)
• . . • I N - ' l ON. :.. SFR(1)bath
312.70
►'/ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 50032
❑Accessory building 0 Multi-family Each additional both/kitchen 25.02
❑Master builder ❑Other: I Fire sprinkler(_„sq.ft) - Page 2
-
•. ::JOB SITE INFORMATION AND'LOCATION Site utilities:
- Catch basin or urea drain 18.76
Job site address ` �1 Oka • ••,'
DrywcU,leach line.or trench drain 18.76
City/State/Z1P: '‘ , G,r�� • 9N1 2 _ Footing drain(no,linear ft.:__) r Page 2
Suite/bldgJapt.no.: Project name: ' Manufactured home utilities 50.03
Cross streeUdirections to job site: I Manholes 18.76
I Rain drain connector 18.76
Sanitary sewer(no.linear ft.:___,) ■ Page 2 IIII
Storm sewer(no,linear ft.: Page 2
Water service(no.linear R:__) Page 2 -
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: . Bacltflow preventer _I 31.27 31,071
BESCRII'T1Oly OF WORK..:. I;
Clothes her 25.02
Backwat er valve
1 was
IC. - fit_ ` % . ■LloAe .afa Dishwasher 25.02
. -
.t. r• %A .r 'A£.. Drinking fountain ME 25.02
Ejectors/sump 25.02
:PROP)ER1Y.OWNER ,' :: . . • .: ❑ITIENANT Expansion tank
12.51
Fixture/Sewer cap 25.02
Name: 25.02
Floor drain/floor sink/hub
Address: Garbage disposal 25,02
City/State/LIP: Hose bib 25.02
Phone:( ) Ice maker IIESI
Interceptor/grease tra 25.02
,: -14 APPLICANT . ❑.CONTACT.PF;RSON . : . trap
Medical gas(value:$ ) � �•Business name: ]1 LAM&c \v C p„..S primer MOB�
Contact name: to , . ._ Roof drain(commercial) MI 12.51
Address: • V ' , A . t. • - I 0 . Sink/ba in/lavatory 25.02
City/State/ZIP: 1..3>'t2.,.\14-r}U-\n - On 00c2 Solar units(potable water) 62.54
"l Tub/shower/shower pan 12.51
Phone:( 5) s�.�3L9')91 Fax::( �) c7'.1�J��� 25.02
Urinal
E-mail: ci;. .. _ , 1 - - �i Water closet 25.02
COIV1 R\\ACxOR Water heater M 37.52
Business name: ' t?, \\S 0. .....• Water piping/DWV 56.29
AddresEisAt `1 QJ-\.1J J^j\ 02 Other: r 25.02
ity/State/ZIP: . •- _._`_ `A A ,t, A' Subtotal
Minimum permit fee' $72.50 Ma r Phone:( ta ) -- ax: + 2 512 Plan review (25%of permit fee)
■ CCB Lie.: L_C.(, . , _ • Plumbing tic.no.: ,lio 11, State surcharge(12%of permit fee) NM
1!� d Tf1TA1.EERMIT Fa '"''. !'1