Permit CITY OF TIGARD PLUMBING PERMIT
11111 2 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/23/2012
Parcel: 1 S133AD12500
Jurisdiction: Tigard
Site address: 11334 SW SUMMER LAKE DR
Project: RAGER Subdivision: SUMMER LAKE Lot: 6
Project Description: Backflow preventer for irrigation.
Contractor: LEWIS LANDSCAPE SERVICES, INC. Owner: RAGER, MIKE L & CAROL J
6107 SW MURRAY BLVD., #108 11334 SW SUMMER LAKE DR
BEAVERTON, OR 97007 TIGARD, OR 97223
PHONE: 503 - 524 -3679 PHONE:
FAX: 503 - 213 -5921
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 02/23/2012 $31.27
Specifics: 1 12% State Surcharge - 02/23/2012 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 02/23/2012 $41.23
Plumbing
Class of Work: ALT
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: .
all 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.
. Feb 2212 04:20p Lewis Landscape Services 503- 213 -5921 p.2
Plumbing Permit Application
Building Fixtures FOR OFFICE USE O.\•LY
City Of Tigard Received Pe®itNo.: -
13125 SW Hall Blvd., Tigard, OR 97�t ,�o \ .: Date. 73 ii- 4rir P�/v� aa)� 6 �g
1 II Phone: 503.639.4171 Fax: 503.5980 1 � p7° Review
, Other <.Permit Alo.:
1 u A R Inspection Line: 503.639 ` Q V
�. �^ �C �Y Agri,: ® See Page z for
Internet: www.tigard-or.gov ' \ �:
IMP. Sumuementat information
TYPE OF WORK kj %% iv G, V' '. FEE" SCHEDULE
❑ New construction ❑ DemOtAr For special irrfarrnaaaa ate checklist.
;QI Addition/alteration/replacement ❑ Other: Description I Qty. I Ea. I Total
New I- 2- family dwellings (includes 100 it for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
III- and 2- family dwelling ❑ Commercialimdustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
CI Master builder ❑Other Each additional b�ath/kitchen 45.00
Fire sprinkler (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities •
Job site address: 14 �l C I Sjta _ L D
Catch basin or area drain I 16.60
City/Stale/ZIP: -T-• t c c- a. c r� � .a_ Drywell, leach line, or trench drain 16.60
j i
Suite/bldg./apt no.: Project name: ° l �� Footing drain (no. linear ft.: _) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
' Sanitary sewer (na linear It: _) Page 2
Storm sewer (no. linear ft.:___) Page 2
Subdivision: I Lot no : Water service (no. linear f .: __) Page 2
Tax map/parcel no.:
Fixture or, item
Absorption valve 16.60
DESCRIPTION OF WORK Batdllow preventer • r Page 2
S1A`j ca �.\ (, ■ C a ( 1 „k) f 1 C R , I Backwater valve 16.60 •
‘ I p - Y sc31 - 14\ VAQ.,- L .c. };P„),y1 Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60 •
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City / State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
•
a APPLICANT ❑ CONTACT PERSON Nose bib 16.60
Ice maker 16.60
Business name: Lw,'. 1_,,,tl\AlSc. 5'k'IlC9..- K1C- Interceptor/greasetrap 16.60
Contact name: J:` i`f Le t S J Medical gas (vain= $ ) Page 2
Address: (DI 0 Sw 1V ( �(a'\` ✓ ! � ` D l V der 16.60
City/StateIZIP: 2 s. , (SR. 97, 005? Roof drain (commercial) 16.60
` I _ -, r p) 2` ,� S .
Sink/basin/lavatory 1 6.60
Phone: (t�"C�) S2 `` Fax: : Tub/shower /shower pan 16.60
E-mail: nC-C' is . l-Fi..v(S\G:, . sr rr1)2. C:,`l. -N Urinal 16.60
CONT``RA�TOR Water closet 16.60
Business name: l -e.:A'a t..., LSs VIA SCCt►r...o_ '<, Ui Ce / Ttr1C . Water heater 16.60
Address: `'- . j�.1 M. «c \rn:`-1 �'' , j i l . ' vi e 1 c ` R Other
CA Ci
1 Ql/l {� Subtotal
Ci ty /StatefZMP: cb c.kV'2W CO-- `� 1 I1 () _
J � Minimum permit fee: $7250 -7,--1 -7,--1 Phone.. (. ) ',Zli U� S 1 Fax: (C ) 2_13 3 2 I Residential bacl�ow minimum permit fee: $3625 / Of - � O
CO3 Lie.: 1 Plumbing Lie. no.: Plan review (25% of permit foe)
State surcharge (12% of permit fee) e g
Authorized signature: 7 L
TOTAL PERMIT FEE ` tJ
Print oar= J 1 i -S Date :. J -7 This perm application es if a- penult is not obtained within- - - --
� 2 2 1 1Z p
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
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