Permit ,, CITY OF TIGARD PLUMBING PERMIT
sillill 'I '-= COMMUNITY DEVELOPMENT Permit #: PLM2011 -00156
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/18/2011
Parcel: 2S102BCO5400
Jurisdiction: Tigard
Site address: 12555 SW PATHFINDER CT
Project: AUDRITSH Subdivision: YOLO ESTATES Lot: 3
Project Description: 65 ft. of water service. Electrical permit may be required if house grounding is affected.
Contractor: LOVETT EXCAVATING INC. Owner: AUDRITSH, JEREMY & CYNTHIA A
PO BOX 86280 12555 SW PATHFINDER CT
PORTLAND, OR 97286 TIGARD, OR 97223
PHONE: 503 - 504 -2847 PHONE:
FAX: 503 - 288 -1630
FEES
Quantity Description Date Amount
65 If Water Service 05/18/2011 $62.54
Specifics: 1 12% State Surcharge - 05/18/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 05/18/2011 $9.96
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 1.800.332.2344.
Issued By: mittee Signature: �
Call 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.
May. 18. 2011 1.50PM Lovett Excavating No. 2899 P. 1
Plumbing Permit Application
Site Utilities �1�!� hc)Ir c)rh'1c 1: USE ONu 1'
Ihi v 13125 SW W H ll Blvd., � ,(� � 1 a �^ Received a
I �fI Permit No.: n rl/J ! U/LJ 10
W Ha Bld., Tigartl.`a
Plan Review
Phone: 503.718.2439 Fax: 13.598.1960 ti '), \ Date/J3y: Other Permit No.:
T tin Alt 17 inspection Line: 503.639.4175 i y Dale Ready/By: laic El See Page 2 for
Internet: www.tigard- or.gov 1 J NNotifiied/Mclhod: . Supplemental information •
- . . x'Yt?E. ;Q)R W r t i, 7
+\ � _ ` FEFi SCHE�UL>4 :",`
❑ New construction iP ill lition For special iriformattan use checklist
' Description I Qty. I Ea. I Total
® Addition/alteration/replacement LI Other: New 1- 2- (amity dwellings (includes 100 R. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
•
El I- and 2- family dwelling ❑ Commerciavindustrial SFR (2) bath 437.78
E Accessory building SFR (3) bath 500.32
❑ Mu lti family
-- - - Each additional bath /kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE iNFORMATION AND LOCATION She utilities:
lob site address! 12555 SW Pathfinder Ce Catch basin or area drain 18.76
Drywall, leach lilac, or trench drain 18.76
Cily /Slap /ZIP: Tigard OR 97223
Footing drain (no. linear ft.: , ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job rile; SW Walnut Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear fl.: ) Page 2
Water service (no. linear ft.: 1 Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
- _ - -� 7 -.. o o a e valve 3 'RLP;II N W REL.
Clothes washer 25.02
replace 65' water service -
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
„ ,❑ PROPERTY OWNER sl ' 0 ,TENANT Expansion tank 12,51
Name! Fixture /sewer cap 25.02
Floor drain/f1oor sink/hub 25.02
Address;
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker - 12.51
a :4PPLICAN'F . ' . Li CONTACT PERSON . interceptor /grease trap 25.02
Business name: Lovett Inc Medical gas (value: $ �) Page 2
Contact name: Candy Markley Primer 12,51
Roof drain (Cummeroial) 12,51
Address; PO Box 86280 Sink/basin/lavatory 25.02
City /State /ZIP: Portland, OR 97286 Solar units (potable water) 62.54
Phone: (503) 504 -2847 I Fox: : (503) 2884630 Tub /shower /shower pan 12.51
E -mail; candice.m @lovettservices.com Urinal 25.02
. c s
' "a CONTRAL`TOR ° Water o ct 25 02
r:ta z�..' , WatcrhCalcr 37.52
Business name: Lovett Inc Water piping/DWV 56.29
Address: PO Box 86280 • Other: 1 25.02
City /State /ZIP: Portland, OR 97286 Subtotal
Phone: (503) 504 -2847 Fax: (503) 288 -1630 Minimum permit fee: $72.50 72.50
Plan review (25% ofpermit fee)
CCB Lic.: 125507 Plumbing Lic. no.: 26 -773PB
S State surcharge (12% of permit fee) 8.70
Authorized signatur { TOTAL PERMIT FEE 81.20
Print name: Can y!v[arllley Date: 5/18/11 Thls permit application expires is n obned o(thin 180 days
aher it has been Ifs accepte d ns cp mplef
*Fro methodology set by Tr - Counly Building lndosiry Servica Board.
r:1 Buildi gg\ Permit nPLMU,PermitApp.dac 10/01/09 41O.4616T(10102/COMRIEn)
'4 36o
/I CO [ 7 / ,
i �. L WORK ORDER/INVOI E INVOICE P (, >I l 1 - DATE
O
ESTIMATE IJ c 19 l ❑
OFFICE: 503 - SERVICE (737 -8423) FAX: 503 - 288 -1630
P.O. BOX 86280 • PORTLAND, OR 97286 CCB# 125507 TECH
EMAIL: office @lovettservices.com • www.lovettservices.com WA# LOVETEI995KQ SEE ADDENDUM LI
JOB NAME: BILL TO:
STREET: _ ( � j F UNIT: �,, ATTN:
CITY: A ' STATE ZIP: . ^ S TREET: UNIT:
EMAIL: J / L CITY: STATE: ZIP:
PHONE: -- 44 _ 7.%q 1 PHONE:
TENANT: D S. t. ) .5- A 6 7 S� C *+ P en
PHONE: VENDOR P.O. #: i VENDOR P.O. #:
•
AUTHORIZATION It th am e wor an k liste owner d b o e r low re /tenant authorizing the performance of
TO PROCEED: Courtesy Inspection: Complete ❑ N/A ❑
SITE CONTACT:
Signature:X
TASK: AMOUNT
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CUSTOMER #:
SUB TOTAL",
CREDIT CARD #: - EXP DATE: CID #:
DISCOUNTS
CHECK #: C.C. AUTH #:
TAX
BILLING P.O. #: TOTAL
JOB RE: LIEN NOTICE ❑
ACCEPTANCE OF
WORK PERFORMED: Signature: X Date: Print Name: •
I find the service and material rendered and installed in connection with the above mentioned, to have been - completed in a satisfactory manner. I agree that the amount set forth on