Permit CITY OF TIGARD PLUMBING PERMIT
'� 1 1 COMMUNITY DEVELOPMENT Permit# PLM2011 -00316
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Date Issued 10/25/2011
Parcel 2311113001500
Jurisdiction Tigard
Site address 10185 SW VIEW TER
Project Mudrow Subdivision GREENBRIER Lot 3
Project Description Install 70' of sanitary sewer line
Contractor LOVETT EXCAVATING INC Owner MUDROW, MICHAEL T 8 DIANE C
PO BOX 86280 10185 SW VIEW TERR
PORTLAND, OR 97286 TIGARD, OR 97224
PHONE 503 - 504 -2847 PHONE
FAX 503- 288 -1630
FEES
Quantity Description Date Amount
70 If Sewer Service 10/25/2011 $62 54
Specifics. 1 12% State Surcharge - 10/25/2011 $8 70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 10/25/2011 $9 96
Class of Work ALT Plumbing
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 quest UNC 503 232 1987 or 1 80 332 2344
Issued 1E4 / J" � CX A,/ ,O y Perm rt[ee Signatua % ( C � J
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
Oct. 25. 2011 8'29AM Excavating CITY OF TIGAf2D No, 5854 P '.. 01/ @1
Plumbing Permit Application
Building Fixtures 'on uv6it'f. 16b: ON 1,1
City of Tigard 1 /O 07 /i . .IA Perth �
We.: ' ao// - p
13125 RW Nall Blvd.. Tigard, OR 97223
Phone. 503.71 11 2439 Fax: 503.598 1960 psi Arnim Oilier Zi nriallo k„ w c1V 7
'T it:Alin Inspection Line. 503 Data Reedy/By Jorlr BI See vnge 2 for
i n t eract; www.tgard- or.gov Nonae4Tenhod: Sopplenentnl lnfonuffon
TYPE OF WORD FEEa 9CHLi8VLE '
❑ New conshrrctinn ❑Demolition Forspechtl Informalion use checklist
Description I Oty 1 En, I Tgsal
❑ Addition /alteratioWreplacemenl ❑ Other: New t• 2-femlltdwelllnp (includes 100 ft, for each utility cornecdon)
CATEGORY OF CONSIRIJCIION SFR (I) bads 312.70
❑ 1 - and 2- Family dwelling ❑ Commercial /industrial SFR (2) bath 437 78
SFR (3) bath 500,32
❑ Accessory building ❑ Multi•fomily Each additional ba h kitchen 2102
❑ Master builder ❑ Oilier. Fire sprinkler ( sq. R,) Page 2
JOS SITE INFORMATION AND LOCATION Site ntllitiesi —
Job alto address: (0 1 86 sc.() V v..) i lam °. Cinch basin orartadrain 18.76
Drywell, leach line, or trench drain 18 76
City/StatefLWP:
footing drain (no Ilnear R. ) Page 2
Suite/bldg /apt,no,: I Project HuC,2nec9 , _Monufteturalhomautilities 5003
Cross street/directions to, job sue: Manhole 18.76
Rain drain connecter 18,76
Sanitary sewer (no linear ft.: 70) Paget
Storm sewer (no linear R.. `) Page 2
Water service (no, linter ft.: _) Page 2
Subdivision: 1 Lot no.: F ! or Items
Tax map/parcel no.: Backflnw preventer 31 27
DESCRIPTION OF WORK
valve 12.51
Clolhev washer 25.02
( ,tA..a (! .( - es— e � i � I CII- Dishwasher 25 -02
Drinking fountain 25.02
BJcctora/sump 25.02
ti PROPERTY OWNER + � I ❑ TENANT Exp:ussion lank 1251
Mama: k t QHA'4.L °f 3( /)n)L Y1141)4040 Fixture /eewercap 25.02
Address . _ Floutdrain/floordrk/hub T 25 02
(pH t y r aw tl IE /tetc. EC. Cal:ogedisposal 25,02 _
City /State/ZIP: -IT re 1 141 O/- 97,L24 _, Hose bib 2902
Phone: ( ) Fax: ( ) Ice nicker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 2502
Business name;
Medical gas (value, $ •) Pogo 2
Printer 12,51
Conant name:
Roof drain (commercial) 1251
Address; Sinlubosin avatory 25.02
City /State/ZIP; Solar units (potable water) 62 54
Phone: ( ) Fax ( ) TIM/shower/shower pan 1251
E -mail: Urinal 29.02
CONTRACTOR Water closet 25.02
Water heater 37 52
Business Onrrlc; tis--'J „Fr ex e.P1141JP14 INie -, Water piping/DWV 5629
Address: kO x g (a 740 Othar. 25
City/Sink/ZIP' 1 L-rL - ,Sr 6 /- q 72 7 (o Subtotal
?hone: (5 5 r Fax: ($bl$)ag f43p Minimum permit tbs. $72.50 4•$2
COD Liu., 1as5o7 Plumbing Lit no: gee -713Th Plan review (2514 of permit fee) r-
7 - State snrcharre(12 %of permit Ice) c 9,70
uthorizod aignatura: ...._.___.------------- TOTAL PERMIT nit .
Print 3 nt name: ` O -i nt
O o Date: [$1Y <I(I This permit nppiicadon expires If p ag•mrtianet nhlnined within 180 days
after d net keen accepted a complete
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