Permit ip CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00344
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/22/2008
PARCEL: 1S133AD-12400
SITE ADDRESS: 11356 SW SUMMER LAKE DR ZONING: R -7
SUBDIVISION: SUMMER LAKE LOT: 005 JURISDICTION: TIG
PROJECT: LEE
Project Description: Installing backflow preventer for irrigation.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SHERRI LEE
11356 SW SUMMER LAKE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/22/2008 $36.25
[TAX] 12% State Surch 8/22/2008 $4.35
Phone : 503- 452 -3460 Total $40.60
Contractor:
LEWIS LANDSCAPE SERVICES
12700 SW NORTH DAKOTA ST
#180 -276 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97223
Contact # : PRI 503 -524 -3679
FAX 503- 213 -5921
Reg #: L1C 8112
PLM PLUS BACKFL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By ��� ` L i ce Permittee Signature:' /� q-1
p j� "�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
''''Aug 21 08 02:30p Jim Lewis 503- 213 -5921 p.1
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Plumbini Permit Application
Site Utilities FOR OFFICE L:sE• ONLY
Date /B a," � - « 'TP ' /g1/�'I 3 � - cx.$
City of Tigard Permi No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 q 2008 Plan R
I Phone: 503.639.4171 Fax 503.598.1960UG 0 Plan Review
Date.By: tither Permit No.:
Inspection Line: 503.639.4175 ti Date R /13 ru[ir ®see Page 2 for
Internet: w
T 1 G r\ R D erww.tigard- or.gov F TIG"' y: g
r� Q - Notified/Method: _ �(, S upplemental loforoatiou
TYPE OF WOBIAILDING ' • FEE* SCHEDULE
® New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. i Total
❑ Addition/alteration/replacement ❑ Other: New l- 2- family dwellings (includes 100 ft_ for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11356 SW Summerlake Dr. Catch basin or area drain 16.60
City/State/ZIP: Beaverton, OR 97005 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.:. I Project name: Lee Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision I Lot no.: Water service (no. linear R: _) Page 2
Tax map/parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK I Backllow preventer I Page 2 32.50
Install backflow device for irrigation system Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors sump 16.60
Name: Sherri Lee
Expansion tank 16.60
Address: 11356 SW Summerlake Dr. Fixture/sewer cap 16.60
City/State/ZIP: Tigard, OR 97223 Floor drain/floor sinkRwb 1660
Phone: (503)452 -3460 Fax: ( ) Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON
Hose bib 16.60
Ice maker 16.60
Business name: Lewis Landscape Services, Inc.
Interceptor /grease trap 16.60
Contact name: Jim Lewis Medical gas (value: S ) Page 2
•
Address: 14314 SW Allen Blvd., 4510 Primer 16.60
City /StateJZIP: Beaverton, OR 97005 Roof drain (commercial) 16.60
Phone: (503) 524-3679 I Fax: : (503) 213 -5921
Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E -mail: jim(a)lewieslandscapc.com
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Lewis Landscape Services, Inc. Water heater 16.60
Address: 14314 SW Allen Blvd., 4510 Other:
City /State/Z1P: Beaverton, OR 97005 Subtotal
Minimum permit fee: $365 3/_)3
`
Phone: (503) 524-3678 Fax: (503) 213 -5921 Residential backflow minimum permit fee: $3625
CCB Lic.: 8112 L C Il'j ' Plumbing Lic. no.: Plan review (25% of permit fee) ae
Authorized signature: �J State surcharge (]2 °'0 of permit fee) 13.05 1/35
TOTAL PERMIT FEE 0 yacP
Print name: James M. Lewis I Date: 08/18 /08 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:\ Building1Pmnits \PLM1J- Pemit.Avp.doc 12/27/06 40 6167(IO'OLCOM/WPA)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008.00344
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/22/2008
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175 ' —
INSPECTION WORKSHEET FOR DATE: 9/4/2008 TIME: 7:02AM PAGE: 22
SITE ADDRESS: 11356 SW SUMMER LAKE DR CLASS OF WORK:
SUBDIVISION: SUMMER LAKE LOT #: 005 TYPE OF USE:
PROJECT NAME: LEE
DESCRIPTION: Installing backflow preventor for irrigation.
OWNER: LEE, SHERRI PHONE #: 503. 452
CONTRACTOR: LEWIS LANDSCAPE SERVICES PHONE #: 503- 524 -3679
Inspection Request Scheduled For: Date: 9/4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 075054 -01 503 - 5243679 N
Corrections /Comments /Instructions:
g PASS ❑ PARTIAL APPROVAL
❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11..A._ )1 la...•..rz. Date: 01 `LJi1,QZ Phone #: (503) 718-