Permit q CITY OF TIGARD PLUMBING PERMIT
• III 3 :- -- COMMUNITY DEVELOPMENT Permit #: PLM2013 00083
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2013
Parcel: 2S114AB05500
Jurisdiction: Tigard
Site address: 9365 SW MILLEN DR
Project: Hoklin Subdivision: KNEELAND ESTATES Lot: 42
Project Description: Replace 60' water service
Contractor: LOVETT EXCAVATING INC. Owner: HOKLIN, LONN L AND
PO BOX 86280 WALKER, PAULA H
PORTLAND, OR 97286 9365 SW MILLEN DR
TIGARD, OR 97223
PHONE: 503 - 504 -2847 PHONE:
FAX: 503 - 288 -1630
FEES
Quantity Description Date Amount
60 If Water Service 03/14/2013 $62.54
Specifics: 1 12% State Surcharge - 03/14/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 03/14/2013 $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: ` � , /� , `. Permittee Signature: NJ / L //r/� �
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. Cart -
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.
-Mar, 14. 2013 12:29PM Lovett Excavating No. 6162 P. 2/2
Plumbing Permit Application
E IV REc
Site Utilities FOR arrlr_'l: usl: i1N1,1
Ca of Tigard Received y: � t� /3 60 alb! 3 -G, 18
�' ll MAR 1 4 2013 DaedO3 Y : Permi No.
13125 3W Hell Blvd., Tigard, OR 97223 Plan Review
:
Phone: 503.7182439 Fax: Line; 503.598.196n Dn Other Permit No.:
11(; A R U Inspection ne e1�
503.639.4175 l!t" , tu, e Dy
RD b Da ate m / Ready/10y: Bl See Page 2 for
Internet: www.tigard- or,gov BUILDIN 0l, . milled/Method: Supptemental Information
I !1' 2.(6 ;:*1' sit) iL - - - ` ti ll ' 1Th -
❑ Now construction ❑ Demolition For special btforma,o,r use checklist.
Description I Qty. I Ea. I Total
Addition /al tcration/replacenlent ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
EE=- - [ta obi `,gs� f}t .1.6J1islt`t = - -7 SFR(l)bath 312.70
on and 2-family dwelling ❑ Co,mnercial/induslrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi-family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
C] Master builder ❑ Other.
p sq. ) g 2
F = E af"ililzliii- Itfj I P'W(iRe3. t i(l1,4931I) t Site utilities:
lob site address: ` 1 Catch basin or area drain 18.76
City /State/ZIP: J +1 - �� +� Drywall, leach lino, or trench drain 18.76
Footing drain (no. linear II:, ) Page 2
Suite/bldg. /apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job ate: Manholes • 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear n.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.:620 Page 2 Wog $y
Subdivision: I Lot no.: Fixture or Item:
Tax reap /parcel no.: Backflowptcventer 31.27
'. __.1 j tT i4,019i6]�;i ?.1lej _;_ : - -_ Backwater valve 12.51
Clothes washer 25.02 • 1 .. _a I ■ `t1 -ACA ± IJ 0 I t Va. Dishwasher 25.02
/n& 1
lliY� Drinking fountain 25.02
Ejectors/sump 25.02
; _�3ald�islln8 •/� [1 II d , A -- pattsiwllank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone: ( ) Fax: ( ) lee maker 12.5
r )� � ktti. :. lj'FT I I LL t` 1f3 e;i.fci h .011C1114,1 I nterctptor/greasetrap 25.02
Business lntme: tM 0' r • Medical gas (value: $ _ ) Page 2
- Primer 12,51
Contact name: 1Oou,ry
a o w Roof drain (commercial) 12.51
Address: wd. r8 cY 870(9 80
Sink/basin/lavatory 25.02
City/State/ZIP: a • 40 ` l ilk • Solar units (potable watcr) 62.54
Phone: rng . • -a a 4-(3 Fax: : Etg •in /10 8 0 1131s/shower/shower pan 12.51
. ` 2 • - w , Urinal
E-mail
f V t e
v_ " : . arc closet o et
zsoz
: Tom:
•
r Water heater 37.52
Business name: )0 .... E
1Valcrpiping/DWV 56.29
Address: r p 0 S � � t &O Other 25.02
City /State /ZIP: Par?, w . ii � T1 g to Subtotal
Phone: /g �r g Fax: • 8 l03 Minimumptxmit $ 72.50 --,I
.y � 3li Plan review (25% of penult fee)
CCB Lic.: ! 4A� 5n r • Plumbing Lie. no
State surcharge (12% of permit fee)
Authorized si :nature;
AA,/ /. it , _t/e. L a,.ijaii TOTAL PERMIT FEE I IA D
=WPM (C e f a- r/1vr Fe A" bat /NM This permit application expires Ira permit is not obtained t+1lhto 180 days
• after It has been accepted as complete.
*Fee methodology set by TYI•County Building Industry Service Board,
1; 19u11dlaeltmmn \PLMU- PermitApp.doc 10;01109 140.4616T(10"02/COM'WEll)