Permit 111 CITY OF TIGARD PLUMBING PERMIT
1 11 - COMMUNITY DEVELOPMENT Permit#: PLM2010 -00351
Date Issued: 10/27/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103AA03200
Jurisdiction: Tigard
Site address: 10465 SW CLYDESDALE PL
Subdivision: Lot: 0
Project: Villalobos
Project Description: Replace 60' of water service.
Owner: FEES
VILLALOBOS, VALORIE Quantity Description Date Amount
10465 SW CLYDESDALE PL 60 If Water Service 10/27/2010 $62.54
TIGARD, OR 97223 1 12% State Surcharge - 10/27/2010 $8.70
PHONE: 503 -624 -1741 Plumbing
10 ea Minimum Fee Adjustment - 10/27/2010 $9.96
Plumbing
Contractor:
METICULOUS HOME SERVICES LLC
12518 NE AIRPORT WAY, STE. 148, #343
PORTLAND, OR 97230
PHONE: 503 - 208 -2812
FAX: 503 - 208 -2813
Type of Use: SF
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ' / Permittee Signature: eA r the./5 r9-77p/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.
10/26/2010 13:28 FAX 503 208 2813 METICULOUS HOME SERVICES 0 001
Plu 1 bin2 Permit Application
Bu ding Fixtures r
, ti: ,,I.i I( 1 1,I: t ,i
C of Tigard \\\I Rem
II C • :..:: 16 tiff 0 -16, Permit No"7" 2O/0 ' o S nia - 13125 SW Hall Blvd„ Tigard, OR aE.
' Phone: 503.639.4172 Fax: 503.598.1W 2,6 7- P y viam ' Other Pert No.:
i . i, Inspection Line: 503.639.4175 0 Date Ready/By: B ere p„ge
Internet: www,tigard- or,guv G�� Notified Ile( Notified/Method: ! e( See lnrfor o
IIIIII1 TYPE OF W iN 9 FEE. scam=
12 N 1 construction r`; * ! I lion For speatal igfovnrat use checklist
Description 1 Qty. 1 Ea. 1 Total
M Ad •, Ilon/alteration/repiacoment ❑ other, New 1- 2- family dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
0 - a! • 2 -family dwelling ❑ CtmtmcrciaVindustrial SFR (2) bath 437.78 •
SFR (3) bath 500.32
(] A ' .: building [] Multi - family Each additional bath/kitchen 25.02
❑ M es* builder ❑ Other: Fire sprinkler (_ sq. IL) Page 2
JOB StlE INFORMATION AND LOCATION Site utilities:
Job site address: fog 45 im el 4� S �h‘„ v Catch basin W area drain 18.76
City /St:` P• �%A� OR � / G � i 2 2-1 deli, leach line, or trench drain
Footing drain (no. linear R.: Page age 2 2
Suite/b ■ gJapt. no.: Project mine: Manufactured home utilities 50.03
Cross " : directions to job site: Manholes 18.76
Rain drain connector 18,76
Sanitary sewer (no. linear ft.: - .) Page 2
Storm sewer (no, linear R.:.,,,, Page 2
•
• Water service (no. linear R.: Page 2 ' Sc}-
Subdivl ion: Lot no.: Fixture or item:
Tax ma ;/parcel no.: ` Baddlow preventcr 1 31.27
DEEUUY 'ION OF WORK Backwater valve 12.51
0 Clothes washer 25.02
Q V \ 1 W' Loa ter Spry• ' _ , Dishwasher - 25.02
1 Drinking fountain 25,02 •
r Ejectors/sump 25.02 •
•
M ' ROPERTY OWNER 0 TENANT Expansion tank 1151
Mane: t t . Fixture/sewer cap 25.02
• ' Floor drain/floor sink/hub 25.02
6 1
d ' n•�'��w " Q9rba$cdispesal 25.02
♦ NYelf1WITA Hose bib 2 5.02
F ax: ( ) Ice maker 12.51
•
1 ❑ APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02 •
Bust • name: 6 , a w i a a, Medical gas (value: $ ) Page 2
•
Contact . ifi a 1, 1 primer 12.51
k drain (commercial) —
com — mercial) 12.51
•
•
Address - �, wp 14 Sink/ basin/lavatory 25.02
ISIMEZ'or • - C a.. . _ • ^� Solar units (potable water) 62.54
Phone: '5o�) , '1 o$ 2 Fax : 5U 0 0Q 0 es,1 3 Tub/showcr /shower pan 12.51 •
E -mail: •4's� �.„ GV , V � p�MD;(1 . corr. Wal _ 25.02
CONTRACTOR --a Water closet 25.02
Water heater 37.52
•
Busin • ani
mc: LtJ1 • r • L . . $- C. Water piping/DWV 56.29 •
• ' ' - ii t : i . Q 1 i ` 4 4 Other: 25,02 •
O . • 1 — • 4 - Subtotal
Phone: ly b ) 4 ; 2 Fax: ( p ) p! .• Minimum permit l $72.50 '7x Sd
I . f Q Plumbing Lic. no.: PAU= _ -" Plan review (25% of permit fee)
I State surcharge (12% of permit fee) : 70,
A ed signature: ! / /( • TOTAL PERMIT FEE gl (�
EZ32 Dom' /a / �
�� T permit applieatien expires Ira permit is not obtained within 180 daft
after N has been accepted as complete.
*Fee methodology cot by'hi- Connty Building Industry Service Board.
I:\9ullding1 mIIs 'LMU- iwrohApp.doc IonnNa 440.46161(10/021COMACEn) •