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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2012 -00339 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012 Parcel: 2S111CC21300 Jurisdiction: Tigard Site address: 10250 SW GREENLEAF TER Project: Lawrence Subdivision: SUMMERFIELD NO.5 Lot: 271 Project Description: (1) sanitary sewer 5 ft Contractor: LOVETT EXCAVATING INC. Owner: LAWRENCE LIVING TRUST PO BOX 86280 BY JANET M LAWRENCE TR PORTLAND, OR 97286 10250 SW GREENLEAF TERR TIGARD, OR 97224 PHONE: 503 - 504 -2847 PHONE: FAX: 503 - 288 -1630 • FEES Quantity Description Date Amount 1 If Sewer Service 11/20/2012 $62.54 Specifics: . 1 12% State Surcharge - 11/20/2012 $8.70 Plumbing Type of Use SF 10 ea Minimum Fee Adjustment - 11/20/2012 $9.96 Plumbing Class of Work: OTR Type of Const: Occupancy Grp: Stories: • Total $81.20 Required Items and Reports (Conditions) • This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: )1 " ' 1I ( - Permittee Signature: ©k, ,4QP �-f t / c Ail (J dV Z Call 503.639.4175 by 7:00 a.m. for the next available Inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. • Nov. 20. 2012 8:27AM Lovett Excavat ing No. 3845 P. 1 Plumbing Permit Application Site Utilities RECEVE City of Received 'J BIVd Date/B l I go a- � Permit No l ?-OD3 3 I NI q 13125 SW H all Blvd., Tigard, OR 97223 NOV 2 0 2012 r� I Phone: 503.718.2439 Fax: 503.598.1960 Plan Rene" Date/By: Other permit No.: T I GA t: D Inspection Line: 503.639.4175 CITY oF TIGARD Date Ready/By: td See Page x for Internet: www.tigard -or.g v V lolrt gified/Melhod: / Supplemental Information :w - .' 1 : "10$ "ciF�.�U • .r'' ; -' r - ... {. :FBE* SCHEDULE . ❑ New construction ['Demolition For special t►Iformaliort use checklist • Description 1 Qty. I Ea. I Total ® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) - . , 'CATEGORY OF •CONSTRUCTION . SFR (1) bath 31230 • ® 1- and 2- family dwelling ❑ Commcrcial/mdustrial SFR (2) bath 437.78 ❑ Accessory building [] Multi- family SFR (3) bath 500.32 Each additional bath/kitchcn 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. fl.) Page 2 . JOB SITE INFORMATION AND 'LOCATION -'',. ` 7. -::: , , .'. Site utilities: Job site address: 10250 SW GREENLEAF TERRACE Catch basin or area drain 18.76 City /State /ZIP: TIGARD, OR 97224 Drywcll, leach line, or trench drain 18.76 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector J 18.76 Sanitary sewer (no. linear ft.: ) I Page 2 Stoma sewer (no. linear ft.: ,___) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: 1 Lot no.: Fixture or item: fax map /parcel no.: Backflow preVenter 31.27 ` :"" :: DESCRIPTION OF WORIC . .. Backwater valve 12.51 Clothes washer 25.02 SPOT REPAIR OF SANITARY SEWER LINE WITHIN DRIVEWAY Dishwasher 25.02 Drinking fountain I 1 25.02 Ejectors /sunup 25.02 0 l = PROPERTY'OWNEl ' . - ' : rn V ATE T..' =: - Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Ploor drain/floor sink/hub 25.02 Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 - ® APPLICANT • , 0, CONTACT PERSON Interceptor /grease trap 25.02 Business name: LOVETT , INC Medical gas (value: S _ ) Page 2 Contact name: JAIME GONZALES Printer 12.51 Roof drain (commercial) 12.51 Address: P,O. BOX 86180 Sink/basin/lavatory 25.02 City/ State/ZIP: PORTLAND, OR 97286 Solar units (potable water) 62.54 Phone: (503) 317 -5358 Fax: : (503) 288 -1630 Tub/shower /shower pan 12.51 E - mail: pntricia.s @lovettservices.com Urinal 25.02 `''• ° : '.. '-` . „CONTRACTOR OR Water closet 25.02 -. ... -zxi .. -.:... _ . . Water heater 37.52 Business name: LOVETT, INC Water piping/DWV 56.29 Address: P.O. BOX 86280 Other; 25.02 City/State/ZIP: PORTLAND, OR 97286 Subtotal Phone: (503) 737 -8423 Fax: (503) 288 -1730 Minimum permit fee: 572.50 72.50 CCB Lie.: 125507 Pltunbing Lic. no.: 26 -773PB Plan review (25 % of permit fee) C(..._. State surcharge (12% of permit fee) 8.70 Authorized signa 'TOTAL PERMIT FEE 81.20 l Print name: PATRICIA SMITH Date: 11/20/2012 This permit application expires MI permit is not oblained within 180 days after it has been accepted as complete. "Fee methodology set by Tri County Building Indusiry Service Board. r:\ ildinalPem,iinPLMU.PemtApp.doo 10101 109 4J0-4616T(10/01/COAUWSS)