Permit CITY TIGARD PLUMBING PERMIT
IA DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00637
DATE ISSUED: 11/15/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S115AA - 01800
SITE ADDRESS: 10873 SW DOVER CT ZONING: R -
SUBDIVISION: DOVER LANDING LOT: 021 JURISDICTION: TIG
Project Description: Water service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 170 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MIKE POTTER
10873 SW DOVER CT Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 11/15/200`. $101.40
[TAX] 8% State Surcha 11/15/200`. $8.11
Phone : 503- 970 -7019 Total $109.51
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W COLUMBIA RIVER HWY
TROUTDALE, OR 97060 REQUIRED ITEMS AND REPORTS
Phone : 503- 667 -1781
Reg #: LIC 23847
PLM 26 -208PB
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.
Issued By: ;1L2„e:767Ti Permittee Signature: .r2c.p
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.
1
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g Received / - .
City of Tigard ����� V � ;� Onic/B , i i 0) 4 �� I
1.3125 SW Hall Blvd.,, Tigard, OR 97223 Plan Review Other Permit Nn..
Phone: 503.639.417 Fox 503,598.1960 1,t i �\. Date/By
24- flour Inspection Line: 503.639.4175 .Y l � +tt ^•I + Date R !B : 1 'a's: l/ � td Sec Page 2 for
;� � 1 L r` ' " y y �JU I lementni lnformatinn
Internet www.Ci.tigard.or.us Da Road /B : sUrr
TYPE Or 010.1 TIGARD FEE* Sc1- TIIIflTLF
BUI k9i r: ‘ Fors eclat in ormarion use checklist
❑ Ncw consmtction B on " _ 8a. Total
• Doscri �tion �ro�
Addition /alteration /replacement - ❑ Other. New 1- 2- family dwellings (includes 100 t}, for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) lxtth 249.20
X1 -and 2- family dwelling ❑ Commercial/industrial
SFR (2) bath — 350,00
SFR (3) bath 399,00
❑ Accessory building ❑ Multi - family 45.00
Each additional bath/kitchen alli
❑ Master builder ❑ Other. _ Firc sprinkler ( sq. ft.) _ Page 2
.1011 SITE INFORMATION AND LOCATION Site utilldes
Job site address: / j� In 4 j ior Catch basin or area drain 16.60
City/State/ZIP: '
Drywcll, leach line, or trench drain 16.60 —
/i � -
Suite/bldg. /apt, no.: Project name: j, Footing drain (no. liner ) Page 2
. 1 Manufactured home utilities .
Cross street/directions to jab site: Manholes 16.60
/ Au" r � / Rain drain connector 16.60
Sanitary sewer (no. linear ft. ) Page 2
Storm sower (no. linear R; ) Page 2IIIIIM ,p
l,nt no.:
_
Water service (no. linear it,: i r! 77, Page 2 ,fell L:
Subdivision: Fixture or item
Tax map /parcel no.: Absorption valve 16.60
P1t cRIPTTON OF WOR Baekflow presenter Page 2
/,,,,,10, Backwater valve Mill 16.60
Clothes wa9hcr I�. 16.60
t "" t,�I 1
f i "" a
Dishwasher a 0,/' ,,, `�
Drinking fourtrai i j
�'• PROPERTY OWNER ❑TENANT E ectors//sum
r 4
J P 'Jr'
� � e ' ; / �?�� l -":.60
Name: i P,xpansion tank E ! a ,- IC
� + /= Fixturclscwcr cap 16.b0
Address: !�/�!
City /State/ZIP; '10 Floor drain/drain/floor sink/hub 16.60
ti[f✓ /V' - 16,60
, X M r O V Garbage disposal
Phone: ( /� �' ( . )
Hose bib 16.60
wea1'PLi<C.'AN'1' ❑ ('CINTACT PERSON
Ice maker 16,60
Business name: Wolcott Plumbing dba Jack Hnwk Plumbin,. interceptor /grease trap 16.60
Contact name; 111 / 4' i / ; , Medical gets (value: S ) Page 2
Address; 1075 W Historic Comm la River Hwy
Primer i6.60
Roof drain (commercial) 16.60 -
City /State/Zll': Troutdale, OR 97060 • 16,60
Sink/basin/lavatory -
16.60
Phone: (503) 235.8784 Fax: : (503) 491 -2932
Tub/shower /shower pan _
F -mail: — Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Wolcott Plumbing dba Jaek Howk Plumbing
Water heater 16.60
—
Other.
Address: 1075 W Historic Columbia River Hwy Svhmtal
City /5tatc/7.,iP: Troutdale, OR 97060 _ Minimum permit fee: $72,50
Phone; (503) 235-8784 Fax: (503) 491 -2932 Residential backflow minimum permit fee: 530.25
Plumbing Lic. no.: 26 -20R PB Plan review (25% of permit fee)
CC
13 Lie.: 23847 State aurchargc (8% of permit the)
Authorized signature: \ 4 / ►..I TOTAL PERMIT FEE 1 jt. C
Print name: toy / ¶! ' Date; an
This permit application expires if a permit is not obt i • . ' thin
180 days after It has been accepted as complete.
*Fee methodoloev set. by Tri- County Buildine Industry Service Board.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00637
13125 SW Hall Blvd., Tigard, OR 97223 • ' ' DATE ISSUED: 11/15/2005
Phone: (503) 639-4171 Jalt.
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/18/2005 TIME: 7:17AM PAGE: 86
SITE ADDRESS: 10873 SW DOVER CT CLASS OF WORK:
SUBDIVISION: DOVER LANDING LOT #: 021 TYPE OF USE:
PROJECT NAME: POTTER
DESCRIPTION: Water service.
OWNER: POTTER, MIKE PHONE #: 503-970-7019
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503-667-1781
Inspection Request Scheduled For: Date: 11118/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 021835-01 503-235-8784
Corrections/Comments/Instructions:
Aii/MW Air ■O
O 7 r'
-
•
' A PASS H PARTIAL APPROVAL El CANCEL NO ACCESS
IL CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: / (1V r -- Date: p Phone #: (503) 718-