Permit PLUMBING PERMIT
CITY OF TIGARD
rs COMMUNITY DEVELOPMENT Permit #: PLM2009 -00143
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2009
Parcel: 25111 BA06100
Jurisdiction: Tigard
Site address: 9680SW" _MCDONALD_ST
Subdivision: Lot: 0
Project:
Project Description: Replacing up to 100 feet of water service.
Owner: FEES
IMT PROPERTIES LLC Quantity Description Date Amount
13960 SW 100TH AVE
TIGARD, OR 97223 100 If Water Service 06/11/2009 $55.00
PHONE: 1 12% State Surcharge - 06/11/2009 $8.70
Plumbing
18 ea Minimum Fee Adjustment - 06/11/2009 $17.50
Contractor: Plumbing
LOVETT EXCAVATING INC.
PO BOX 86280
PORTLAND„ OR 97286
PHONE: 503 - 288 -1527
FAX: 503 - 288 -1630
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: v CC\ a � ., (1 Permittee Signature: ag V(
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.
-, .
Plumbing Permit Application
Building Futures r >Ii OI I it 1. 1 t; ( ) \i.1
City of Tigard
13125 S W Hall Blvd, Tigard, OR 97223 l 1 t Dam = 1 o Permit No.: v� 00/
Phone: 503.639.4171 Fax: 503.598.1960 , n Plan Review •
Inspection Line: 503.639.4175 Date/By: Other Permit No.:
1 I nSpe
Date ate Reed
tercet www.tigard-or.gov
gov
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0 New 0OD3tru ❑ Demolition For spedal information use checklist
I. Addition/alteration/replacement ❑Off
Description I Qty I Fa I Total
i • ft, i i 'F '(I i €: ° }�r" t � + , ate Low+ r irl rxi 4e r tritI r r rr r New 1- 2- family dwellings (includes 100 ft. for each utility connection)
'§ rl i« I . I. e r .11i e J ti { 1 d ``5 Sr
,, Anr i ta i luiigt!rriiirti, :-.i >FS- liilitss;r f� iiti u 1,t.i .1V.:ii hair ;i t41 .:ti SFR (I) bath 249.20
G 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder 0 Other
T ,►yer. k i
al a, € tee ti n t r ,i g1ts1 r na t , r u nv 1 a 11r i,^ ; w.• e : • Fire sprinkler ( sq. ft.) Page 2
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h! at .e..tuu..� lei. Arlo; �s ..F.ls.,sis.u311.11�,, :'1wl�ir,tv�fli^.�..ik: 10. Site utilities
Job site address: g Lego .t W M c.r! (.7 rt•ci 10 -I
,� Catch basin or area drain 16.60
C i t y / S t a t e / Z I P : edal in e a ? , . V 012 7 4 Drywcll, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: Footing drain (no. linear ti: _) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
•
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft.: _) P age 2 -
Subdivision: I Lot no.: Water service (no. linear ft: $.) f Page 2
II Tax map/parcel no.: Fixture or item
s(11 e' a €'If,�{ S� 3,1n r 1) 9 s y i.-_. L i !i'J .-n"; T k a M1lr Ill "' n r M i n
Absorption valve
°t4 y'r g� i ,�€ ilal igi +. E ; J . r �P TFV i a fIF i ii ii. a ITMU 1ninl O 16.60 ,
1s• i lioil.4 1(ritio...ii.l . i aF, :tisliiiw!: 4ax!_ 4• c�; rai , 414 ' °t :ik) Baciaawpreveater e2
/' 0 te,t, / ✓L D / q p t Ti 4 €'v t Backwater valve 16.60
Pp -e-a/f1-- Clothes washer 16.60
q � Dishwasher 16.60
"Ff ; '�,4��1 ` :p" l � 1 �; `- i «F 3�j�'ie ' iRa�F F A 4 I � h ' i l°I; •SR+''�? itu . t1S'ug,isoilira � M
:► Iti 1111. liNt.uatili391i. o.14., . 1 .*Iiilat ,tWV1 44 .wm.P 1 i l A1 ; ,41 :i.4i ,'f" IdA'49J,1' Drinkin fountain 16.60
Name: 6jectors/sump 16.60
Address: Expansion tank 16.60
Fixture/sewer cap 16.60
City/Slate/ZIP: Floor drain/floor sink/hub
16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 •
1� 1 5! . r10 o i 1 �f t Hose bib
1 1 x s , �I�
1 { Pi f, 11) 1 r a2 1' u s1 i ltNr�i iA �.i f7J . ' . '�I A, : X14 i li e ll:Au M1u.rat �^ $}t.1 16.60
._,r,,r..4i v� ,^t, v;,,, ,f At.:t�n;�f�t s, -k- t tlll U ti..,L .' ,rs�_.:�U:7l EIIXS�II L�' Y'dii, ti lee maker
Business name: Ns- ► �.e h -� i R I P�, r-Yt 4 : 3 ) n 16.60 ,,
Contact name:
a a .-- ,' c l f.6 J I-,-et 64 Medical gas (va trap age 16.60
2
Medical gas (value: $ ) Page 2
Address: Po 6 3/ �7 c) Primer
p �J 16.60 '
City/State/Z1P: ` 4i , K c..1 / (A e G'! 0 CP Roof drain (commercial) 16.60
Phone: (1ty5) z . i 52(.r I Fax: : 6 186. /Le Sink/basin/lavatory 16.60
E -mail; Tub/shower /shower pace 16.60
+ {1�'" }'S, 4r { },y� + + "r'(f 1�irtlt%dt,t[r r ,Jl riiG °?� ix ri�+ r r �,, y' y Urinal 16.60
v �Lll i I dr F f A" ►t'/ !I b i�IJ> i 1 r I y 1 f I - +: i ?d2a -,f i erX 7�+yii }33 "likrc _
ie t,�.4 ii4. ..a1,..;_ +.u. nJr.,.,31,u t ri. 1 ? frr'ashsi t�F'ou' k'_ lltab. "! Water closet --
Business name: - ,. • _ .. - - Water heater t
16.60
Address: Ida 60y B!o 2 e, V 0141 (-0, Ex(ti lava �'t Guterp -
City /State/ZIP: Pa ✓r % r-•. c4 r, r ei 7 Z (3 G ' ' " - subtotal
Phone: 6D Z Minimum permit fee: $72.50
� 6 . I 52 7 I F ax: (So3) 2.8 5 , 1 Le3 0 Residential backflow minimum permit fee: $36.25
CCB Lie.: / 5 1 Plumbing Lie. no.: Zvi -1-73(6 - Plan review (25% of permit fee) -
Authorized si 1 . (( State surcharge (12% of permit fee)
1 •� TOTAL PERMIT FEE `
m
Print tae: - I J ,, ' . , ( J tncA 0 I Date: big/Pei I This permit application expires if a
PP pi permit Is not obtained within
180 days after It has been accepted as complete. •
*Fee methodology set by Tri- County Building Industry Service Board.
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