Permit 1
CITY OF TIGARD SEWER CONNECTION PERMIT
'' COMMUNITY DEVELOPMENT Permit#: SWR2021-00207
Date Issued: 8/3/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111CB01741
Jurisdiction: Tigard
Site address: 10455 SW HOODVIEW DR
Project: Nelson Subdivision: HOOD VIEW NO.2 Lot: 40
Project Description: Sewer connection for existing dwelling.
Contractor: Owner:
n NELSON, JAMES R& LINDA S
10455 SW HOODVIEW DR
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/03/2021 $6,085.00
Sewer Inspection-Residential 08/03/2021 $35.00
Type of Use: SF Reimbursement District Fee 08/03/2021 $32,973.15
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
f
Total $39,093.15
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 es
Issued By: C t:5 �/`4�' !� -/ 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.
RECEIVED
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT JUL 2 9 2021
11
3 Reimbursement District Payment Worksheet+TY ow TiGARD
TIC,1 R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.718.2439 • www.tigard-o BUILD ING DIVISION
Phis worksheet must be completed by the Finance.Department and provided
to the applicant to submit tokether with a completed plumbink permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 10455 SW Hoodview Dr
Reimbursement District #:45 Parcel #: 2S111CB01741
Amount Due: $ 32,973.15 Amount Due Expires On: May 24, 2022
Applicant: James Nelson Daytime Phone:
Email Address:
El Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee,if applicable)*
By: ;Sir Date: 7/29/21
Name
Printed: Saul Chavez-Hernandez
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait for journal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ 303 973./-5- Receipt #:
SWR#: J'/2.02042/- aO,...21) 7 PLM #: PG/7 002/"
Enter arc.e1 conditions in Accela (check all that apply):
U��'" Enter "paid" condition.
Enter "deferral" condition,if applicable.
By: Z475 eaL4, ./. F7?/.�o� /
Name
Date:
Printed: AiE`C-
Attach this worksheet to issued sewer permit for records scannink.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx
CITY OF TIGARD Vt., PLUMBING PERMIT
COMMUNITY DEVELOPMENT 11 Permit#: PLM2021-00328
Date Issued: 7/30/2021
T I G A_R.O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111 CB01741
Jurisdiction: Tigard
Site address: 10455 SW HOODVIEW DR
Project: sewer Subdivision: HOOD VIEW NO.2 Lot: 40
Project Description: Connect home to sanitary sewer service on property.Decommission septic.
Contractor: TCJ CONSTRUCTION Owner: NELSON,JAMES R&LINDA S
19750 SW PAGE CT 10455 SW HOODVIEW DR
BEAVERTON, OR 97007 TIGARD, OR 97224
PHONE: 503-320-7831 PHONE:
FAX: 503-259-2432
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 07/30/2021 $62.54
Specifics: 1 12%State Surcharge- 07/30/2021 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/30/2021 $9.96
Class of Work: NEW 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
Issued By: Permittee Signature: 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.