Permit CITY OF TIGARD PLUMBING PERMIT
ill ` I . COMMUNITY DEVELOPMENT Permit #: PLM2013 00432
T [ G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/17/2013
Parcel: 2S 1100004000
Jurisdiction: Tigard
Site address: 15695 SW OLD ORCHARD PL
Project: KURISU Subdivision: SUMMERFIELD NO.3 Lot: 142
Project Description: Backflow for irrigation.
Contractor: LEWIS LANDSCAPE SERVICES, INC. Owner: KURISU, HOICHU TRUST
6107 SW MURRAY BLVD., #108 PO BOX 23623
BEAVERTON, OR 97007 PORTLAND, OR 97281
PHONE: 503 - 524 -3679 PHONE:
FAX: 503 - 213 -5921
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 12/17/2013 $31.27
Specifics: 1 12% State Surcharge - 12/17/2013 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment - 12/17/2013 $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 . . `
Issued By: c..---- ' — Permittee Signature: �-' 4 7 , 96 -- -1 C -07. '
Ca 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.
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Site Utilities 11 V 1012 OFFICE LASE ONE
City of Tigard 122013 Date/B. y /i- 13 R.---7-) Permit No.: �]I/y�2c 13 _� [t
- 13125 SW Hall Blvd., Tigard, OR Pi ttevicw /�� taS
Phone; 503.718.2439 Fax: 503.598.1 U, Other Permit No,;
a CITY OF TIGA 1D , y :
Inspection Linc: 503.639.4175 Date Ready/By: Sun,:
• ` TtGA RI ) Internet www.tigard- or.go y: B1 SecPa�2
RUlL.nj NC n iy �t ' pN
ISION Notified/Method: $u ementa! Information
TYPE OF WOR FEE* SCHEDULE
❑ New construction ❑ Demolition
❑ Other: For special information use checklist
Description Qty, Ea, Total
T
�7
Addition/alteration/replacement New 1- 2- family dwelling); (includes 1 ft. for each utility , connection)
CATEGORY OF CONSTRUCTION SFR (1) bath _ 312.70
[ 1 - and 2-family dwelling g ❑ Commercial /industrial SFR (2) bath 437,78
SFR (3) bath 500,32
_, ❑ Accessory building ❑ Multi - family Each additional bath /kitchen 25.02
N i ❑ Master builder ❑ Other: Fire sprinkler ( s q. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: rl s 9 s cSU] p 1r1 0I r � l Catch basin or anla drain t 8,76
IP:
Drywetl, leach line, or trench drain 18.76
City/State/Z
Footing drain (no. linear ft: ) Page 2
Suite/bldg./apt. no.: Project name: w
y S Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18,76
Ruin drain connector 18,76
Sanitary sewer (no. linear ft,: _) Page 2
Storm sewer (no. linear ft.: __) Page 2
Water service (no. linear ft.: Page 2
1 Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no_: Backflow proven= ` 31.27
+, DESCRIPTION OF WORK Backwater valve 12,51
`� a c • , \ \ ■ Z.-Q.., Clothes washer 25.02
C Dishwasher 25,02
•N ` CyNi O� S "� j NtY1 , Drinking fountain 25.02
JJ Ejectors/sump _ 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain /floor sink /hub 25.02
Address:
Garbage disposal 25.02
icy /5tatc/7.1P: Hose bib 25.02
i Phone: ( ) Fax: ( ) Ice maker 12.51
'g APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: �.ee Medical gas (value: $ ) i Page 2
.�d..)1 c, �h��C nr 0i C2 j�'►C - Primer 12.51
Contact name :' ,t.,� 1.('r1/4n)- Roof drain (comtrtercial) 12.51
Address: (O\0 - 1 j VC\ J\crc,\ , C6"\\-1 �, * koq Sink/basin/lavatory 25,02
City /State/ZIP: 2)CS., k0n 1, l___ j 'i 13�' Solar units (potable water) 62.54
Phone: ( '3 ).S2..% .\ 3 (.7-1 c1 ` Fax: : (5 52) 2..V3-59-2_, 1 Tub /shower /shower pan 12.51
E -mail: ci cNCR jtS \C•,YNgS ( 0-, c 7 . - CAWS, Urinal 25.02
CONTRACTOR Water closet 25.02
Business name: 1 Water heater 37.52 •
L- ZN�� S 6 C Ct. �R c�V r�1 �'-fQ r �Y\C, Water piping/DW V 56.29
r
Address: -1 ^' . t. + , .. - 1 Other. 25.02
City /Stute/ZIP: i mbc . , • • --1 Subtomi
Phone: 9.-S?"—SC) Minimum permit fee: 572.50 '72_s 0
((J S Z� ^.JLP -1 ,S Fax: ( ) IA
CCB Lic.: Lt c tg `'` c�• Plumbing Lie. no.: Plan review (25% of permit fee)
State surcharge (12% of permit fcc)
Authorized signature: TOTAL PERMIT FEE iy
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15695 SW OLD ORCHARD PL, TIGARD, OR,
97224
Residential - Plumbing
395 Misc. inspection
2014-01-06 00:00:00
PLM2013-00432
PASS
Lawn irrigation device: 1" wilkins model 350, serial no. A321600
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
15695 SW OLD ORCHARD PL, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
2014-01-06 09:42:00
PLM2013-00432
PASS - No C of O
Violation Summary:
Inspector Contractor