Permit �` °, � � , �' , , tir CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00153
t" Date Issued: 05/11/2010
,TIGARDi 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 25111 CB00300
Jurisdiction: Tigard
Site address: 14875 SW 103RD AVE
Subdivision: DEL MONTE SUBDIVISION Lot: 2
Project: Dickey
Project Description: Replace 120' water service from meter to home.
Owner: FEES
DICKEY, TIMOTHY A & Quantity Description Date Amount
14875 SW 103RD AVE
PORTLAND, OR 97224 120 If Water Service 05/11/2010 $100.06
PHONE: 1 12% State Surcharge - 05/11/2010 $12.01
Plumbing
Contractor:
LOVETT EXCAVATING INC.
PO BOX 86280
PORTLAND„ OR 97286
PHONE: 503 - 288 -1527
FAX: 503 - 288 -1630
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
"o cre5;) ,
Issued By: Permittee Signature: D/v 1
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.
May. 10. 2010 9:52AM Lovett Excavating.. . _ No. 4568 P. 1 7
PlumbinE Permit Appli i4;tto �� ,', --- F�...
Building Fixtures 1 rcpt Orrlci: USE ()NIA'
City of Tigard MAY 1 1 R`oeiv.d _5-00
Permit No -:
i - • U 1 3125 SW Hall Br„ d., Tigard Ok 97223 2010 DateBy: _ /'G - _ - - /D -aa'S
Plan Review
Phone: 503.639.4171 Fax tlg I Date/Oy: Other Permit No.:
Inspection Line: 503.639 � Ark
TIC \ It fl Internet; www.ti and or. v � DIN G �t�> 5 • Dat Iwi. eeIfor
8 g tl V ��f ® Notille avlethod: i S upptemenemeulel lnformalion
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3 a n'YP Q oW : ; : .n!:I 0 ` = :tfir . ' 4 4011 ' x a '
❑ New eOnStnletion ❑ Demolition Forspeclal information use checklist.
Description 1 Qty, 1 Ea. 1 Total
❑ Addilion/altcration/replacement ❑ Other: New 1- 2- fnnllly dwellings (includes 10011. for each utility connection)
CATEGORY, OT COIVSTRTJCTZQN7`'! ':v , ;:: SFR (1) bath 31230
and 2- family dwelling ❑ CommerciaUindustrial
❑ Mulli•faltlily SFR (2) bath 437.78
SFR (3) bath 500.32
building
Accessory
Each additional bath/kitchcn 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) , Page 2
-: nt9c pB IT>r:II --.F D LOGAT Site utilities: ,
Yob site address: ](, , r - /y am e e - z&) f 6) ' � Catch basin eh area drain 18.76 or
City /State/ZIP: - aY 4 aie ) C -1%p9 -r3,Li Drywall, leach line, n e trench drain
18.76
i Footing drain (no, linear R.; ) Page 2
Suite/bldg. /apt. no.. I Project name: _ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 _
Rain drain connector 18.76
^.w Sanitary sewer (no- linear ft.: ) Page 2
Stonn sewer (no. linear ft.; _,_) i Page 2
Water service (no. linear 11.: t2.67 Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31,27
,� 7 �,�E &- a� Backwater valve 12.51
K �: _ .A: e I tZ , Q, Q u- iz� `a -..:?. '` Q Q � p ,,��] Clothes washer 25.02
p - p r� � /�( ! �r� ! * r Dishwasher 25.02 T
ru, L,r }� V 1IN\L rG 1 210 ' Drinking fountain 25.02
Ejectors/sump 25.02
t r iss :x$ expansion tank 12.51
❑ 1PitoP1ERT,V O'l'f�T]Eit ' r ' '
Nome: Fixture /sewer cap 25.02
Floor drain/lloor sink/hub 25,02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
' ? f PPLICANT •CONTACI ;PEIRSON 1 ` lntcrccptodgrease trap 25.02
py
Business name / _ i Vert i ( �1 Medical gas (value: $ ) J Page 2
a• �' "��'�11� ��' '�` Prtmcr 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sinldbasin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Pak:: ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
• m ?r Water closet 25.02
om CONTRACTOR ,
,-� 11 � 1Vater healer 37.52
Business name: 4ti Vv 1 ( ei(Ct a f /1 l Water p iping/DWV 56.29
Address: P 5 U _ 1if 7.4?-0 Other: 25.02
City /Slate/ZIP: 0( rd 012_. 9 ` •� Q l Strbioral /00 r 16
pone: (7 ) Tog . 2 Fax: (• )) c. g� •i( � • Minimum permit fee: $72.50
�
Plan review (25% of permit fcc)
CCB Lic.: 2y��0 Plumbing Lic. no.: 21„ x
p ern /
c) ,
Authorized signature: TOTAL (12% PERM of »t PE / /� d2 . d
Print name: ,/_.( ��/ DRIe�j / This permit application expires ira permit is not obtained within 180 clays
L arf 1 1 d / �U State surcharge after it hos been accepted as complete.
" Fee methodology set by Tri- County Building Industry Service Board.
1:l auildinalPermits1PLMU- PermiIApp 10/01/09 •140- 9616T(I0 /(i/C0MAWA) •