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Permit : . `,, CITY OF TIGARD PLUMBING PERMIT '�! 2 ` COMMUNITY DEVELOPMENT Permit #: PLM2011 -00250 -FW WA D, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/04/2011 Parcel: 2S112AC01801 Jurisdiction: Tigard Site address: 14965 SW 72ND AVE Project: Oregon Bolt Subdivision: Lot: Project Description: Replacing 55 ft. of storm sewer. Contractor: LOVETT EXCAVATING INC. Owner: RBJ INVESTMENTS, LLC PO BOX 86280 PO BOX 23175 PORTLAND, OR 97286 TIGARD, OR 97281 PHONE: 503 - 504 -2847 PHONE. FAX: 503 - 288 -1630 FEES Quantity Description Date Amount 55 If Storm and Rain Drain 08/04/2011 $62.54 Specifics: 1 12% State Surcharge - 08/04/2011 $8.70 Plumbing Type of Use COM 10 ea Minimum Fee Adjustment - 08/04/2011 $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: Permittee 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. Aug. 3. 2011 1:04PM Lovett Excavating No. 4415 P. 1 Plumbing Permit Applica ioi , Site Utilities .4..a i VOlt OFFICE 1,I5F, ONLY City of Tigard Received P nttit No.: > _ g DateB : a' "› a £7 e _L , ( ? S ) a 1 3125 SW Hall Blvd., Tigard, OR 9 2 G 0 3 2011 Plan Review 1 Phone: 503,718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: r I c. R ► Inspection Line: 503.639,4175 Ui rY OF T!GA RD Date Ready/By: rids Elf See Page 2 for Internet: www.tigerd- or.gov Rion fil4fs Ilil/ICir aI Notified/Method: JD"r• Supplcmenlal x , T W ORK : �" PEE 'SCIi1g1DtJ0- " El New constnlclion 0 Demolition For special Information use checklist. Description , I Qty. 1 Fa. i Total fZ Addition /alteration/replacement ❑ Other: Ncw 1 - 2- family dwellings (includes 100 ft. for each utility connection) ., CATEGORY OF CONSTRUCTIIN , SFR (I) bath 312.70 • 111 1- and 2- family dwelling ® Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - family Each additional bath /kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. R.) Page 2 .JOB SITE INFORMATION -ANDi :;LOCATION Site utilities: Job site address: 14965 SW 72 Ave Catch basin or area drain 18.76 City /State /ZIP: Tigard, OR 97224 Drywall, leach line, or trench drain 1 8,76 - Footing drain (no. linear R.: ) Page 2 Suite/bldg, /apt, no.: 1 Project nano: �, y i�Jl t l�,/ & '� Manufactured home utilities 50.03 Cross strect/dircctions to job site: ` Manholes 18.76 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ,_,) Page 2 Storm sewer (no. linear ft.: 5_5) 1 Page 2 62.54 Water service (no, linear fl,; , ) Page 2 Subdivision: Lot no.: Fixture or Item: Tax map/parcel no.: Backflow preventer 31,27 Backwater valve . > . , . e g , � ; DESCRIPTION : OF WORK: ; ja4y ( , Backw 1 12.51 • Clothes washer 25.02 Replace 55' of Storm Sewer on property Dishwasher 25.02 Drinking fountain 25.02 • Ejectors /sump 25.02 • A' . ❑ - .. ° _Y6.. , X ❑ A r ti Expansion tank 12.51 , - �� :1�,,, �.. .:..... ...; :,�,..,: ,, . .... ; _ : TEN NT � • "��'.v,�; Name: Fixture /sewe ca 25.02 - Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25,02 City /Slate /ZiP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 1 12.51 L 1 w - '' - 1nICrCCptor / 25.02 Business name: Lovett Inc Medical gas (value; $ ^ ) Page 2 Contact name: Dericic Droz Primer 12.51 Roof drain (commercial) 12,51 Address: PO Box 86280 Sink/basin/lavatory 25.02 City /Slate /ZIP: Portland OR 97286 Solar units (potable water) 62.54 Phone: (503) 737 -8423 Tax:: (503) 288 -1630 Tub /shower /shower pan 12.51 E-mail: jim ©Iovettsei sices.conl Urine! 25.02 ., , ?;:,' ;,r :: CONTRACTOR :.,p��' - ' :1 "Ina' 1 tIli�',r...;ii Water closet 25.02 �l = • .:: ... •• _ :,'. - .�.; >, �� Water healer 37.52 • Business name: Lovett Inc / See Above Waterpiping/DWV 56,29 Address: Other: 25,02 City /State /ZIP: Subtotal Phone: ( ) Fax: ( ) Minimum permit fee: $72,50 _ 72.50 CC/3 Lie.: 125507 A Plumbing Lie. no.: 26 -773 P Plan review (25% of permit fcc) P-) State surcharge (12% of permit fcc) r• 70 Authorized signature: ` _ TOTAL PERMIT FEE 81.20 Print name: Jim Banorno 'Date: 8/3/2011 This permit application expires If a permit is not obtained within 180 days atterIt has been nerepted as complete. 'Fee methodology set by Tri•Couety Boiiding Industry Service Board. 1:1 Building \PermitsnPLMU- PermilApp,d0o 10/01/09 4 -00.46167(10 /02/COMAVHD)