Permit k =? V
CITY OF - -IGAR® PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM201000197
Date Issued: 06/18/2010
T I+GXat 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S111CB01739
Jurisdiction: Tigard
Site address: 10430 SW HOODVIEW DR
Subdivision: HOOD VIEW NO. 2 Lot: 38
Project: Stevens
Project Description: Connect existing house to sewer service. Reimbursement District #45 fee paid 6/18/10 B.T.
Owner: FEES
STEVENS, LINDA SUE Quantity Description Date Amount
10430 SW HOODVIEW DR
TIGARD, OR 97224 80 If Sewer Service 06/18/2010 $62.54
PHONE: 503 367 -2958 1 12% State Surcharge - 06/18/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 06/18/2010 $9.96
Contractor: Plumbing
TCJ CONSTRUCTION
19750 SW PAGE ST
BEAVERTON, OR 97007
PHONE: 503 - 320 -7831
FAX: 503- 259 -2432
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: Permittee Signature: - Y/r
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.
Jun 12 10 09:39a TCJ Construction 503 2 5 9 2 4 3 2 p . 1
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Building F,tures „ ,,,, "44."'"x Aniral'iNFArrSrAhr
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I Cit of Tigard e , /6
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i i Tcrin it No.:
$714/14'. • 1312s y sw 11411 rilvd,, Tigard. OR 9'7223 JUN 1 5 2010 Rthd
i tm Res, --
',i ,7'," . y Phone. 503.639.4 t 7 I fax 563.5911. I 9114(1,.„, , ,..„ i. ... „
- A rli-J% Dain'ily. Other Peomit No.i fey' Ceeg ,
Inspection t.ine: 501639.4175 Ul I Y U. ILli-kriu Date strodynty 1.77 lil See Page 2 for
ct
tnt.,1'N'I Imero. www.ligard-orsov RI 01 now, n pair...v.4,km : ,. amass' Informal'. • .
. i-...1.:. :: : - •. • • • TYPE OF WORK • ir -..; . ..... - - . • 0 . ... 1: '/ .. 4114 7 .' : 2-;:g 4 ,; 4 b.it i. •'....
. ,• ...tql .., .c,' - : • '
ip Ncvd consiruciikal 0 Dtmalition Fut - special lufanuallon use checklist.
- .. - - - - Description 1 Qty. I Ea. I Total
D Additionialteratit.tdreplacemenl 0 Other New I - 2-Immily clwcnins% (includes 100 I1 for each utitil connection)
. ALL,- c•:.....
C.ATEGORY OF CONSTIIIICTIO SFK (1) bath 312.70
. , . . . • - -
. SFR (2) bath 437.7d
CI 1- and 2-finnity dwelling 0 Commercial/ludo:Arial -
- - SFR (3) bath 500.32
• 0 Accessory building 0 Multi .family
- Each additional built/kitchen 25.02
0 Master builder 0 Other: Eire sprinkler ( sq. ft.) Page 2
___ . ...
.'' , ;' ''.: • .10) OS SITE INFORMATION AND LOCA, ON,..., , She utiIiiim __
jot site address: j 0430 ciA) t 0 ed ii -- ---- Catch basin ot area drain 18.76
tiiiii) ...
Itrywen, I11 lint, or trench drain 18.76
City/State/ZIP: -- ri r 1 . .. -7 6?",. 1 1 _ -- - Footing drain (no. linear ft.: ) Page 2
Suite/1111.16./apt. no.: Projcel name: Ealf.t . .. manufdetuted honk utilities -.
50.03
-._ ..
Cross strevtAlirecrions to job cite: Munholt.• 18.76
-
- 1 -1 --Itf)cil o-eu) Rain drain connector 18.76
Sanitary sewer (no. linear R.: . 4111 Page 2
- • • - Sinn sews/ (no. linear ft.: _,...) Page 2
_ . . .___ .. ... _ W8147 service (no. linear ft.: ____) Page 2
Subdivn: _I Lot . no.' Fixture nr Item :.. . ..
..--...-- -
To mapiparecl nu.: 15ackflow preventer = 31.27
-r - 7 -
DESCRIPTION OF WORK ...:. Rackwater valve 12.51
' - -..-- ..-
• -.• a .. v.,....
....... . . Clothes washer 25.02
-5-EAALlaD k v1/43 Y_LifraTissicoAlcc II st-rif H 25.02
-
Drinking fountain 25.02
,...,____ ......_ ---- - • _
Ejectorshump 25.02
j v :OWNER : I --el---Wrr 1-:. WI 12.51 .,
Mane! c r -4c„....-10\reyis - Fluty ndsewer cilf
-......... . 25.02
\
..-----■ Fluor drain/num sinlJhub 25.02 MIMI
Address; 4' _S Fig6 7 ,...&„‘.) bi i_.
_ liorbage Ji.pusal 25.02
City/Start:17V: . 1 t(jf rr 0 9 4'7 a (34/
,) • - • • • licise hib
• -- --___ . .._ 25.02
P at hone: (561,) - • .-g Fax: ( ) kr make! 12.51
. ---
.! • ' ', :'-' A. " ..• 0 APAltANT . • : ' . . 0 *WON Interceptor/grease trap 25.02
Medical gas (valise. $ )
Businc SS 11111TM:: ,
Primer I Pligt 12.5 2 1
Contact 1M111C:
_ itnnf dram (1...annttercial) 1151
Atidit:S: Sink/havinflavalniy 25.02
-*-- ----
Cily/StaWritr: Snlin units (potable water) 62.54
Phone: ( ) [fax: . ( ) Tutildiowerishower pan 12.51 .
E-Mail:
2hina 25.02
..:„.• • . , • - - Water closet 25.02
, 4;••••• 4 ".ni •-." i .' CONTgAcTOR - . .i 7FF,'
Water heater 37,52
Onziness name. r - c - j - cisp c h aA _ l
s-IT it •
Water piping/DWV
56.29
__..
Address: iq 7 5- e t a /462 a
011ici: 25.02
CitylStitiv/711': 4.40102 d, 7Z... 97co "z RP: Subtotal
Phone: (.Q," 1 52,- '7 g3 ra-1: ( 3d 3) asTi- 3a, _ _____ . Minimum permit fce: $72.50 . 7g • go
..A
Plan review (25% of permit ree) 0.
CCB Liu.: / m 7 _ i ., /2_ Plumhing I,ic. no.: nf .. ,-- • --
(...r .-- slaw surcharge (12% of permit fcc) '7Q
Atithorided sigitature: C_. -----" TOTAL PERMIT FEE C Z ( . 2,0
print ome.-1-Q, „..)z-t,.,.......-LL. I r) . ate: ( P - / a - )b 1 Thep permit stylisation mires If a per ash Is mot ohieherd within 11,0 dap
after Is has been nccepted n complete. . •■
'Pen: methodology set by Tri-Cotmty nandiatt imitotty Svr vice Bahia.
INIeuiteisel'...itirtstu.r....1A, An.: tfrva9 4o3
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Jun 30 10 05:34p TCJ Construction 503 259 2432 p. (' Z- 9- 1 p ejLa_ W._ ' i 1
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BUILDING DIVISION p 97 , � J 1 DAT (TIME
CITY OF TICARD �"` 1 ii, .., N in R TAKEN :Y J O
Goodman Sanitation, Inc. ALT PHONE Q _ _
1 OTED !l #j
931 NE Harlow Place -- Troutdale, Oregon 97060 Troutdale/Gresham: (503) 666 -2280
DEQ #34611 P -1
www.goodmansanitation.com Hoodland: (503) 622 -1111
R SS: hal---, �( �� Damascu�s� 3) 653922
VIt AD E 3 >1J3 ' U , ' 11
SER � •
COUNTY: A. 4 4.
� \ IS B • AME DDRESS (if different): `_ ,`� ' .� j .,.1"...4
" pL,1("1 c .,Oto -6-0/57- .
JOB DESCRIPTION:
_..... A A .-0 Adrai it . 1,1 i. A ii/k_ J L Q .A.' I
, IllWii-1-611i - le 1 S t '
f Tit , l I
ElEl (.
1 I PUMPING TOTAL: 6
DATES DULE
LABOR' '"--
AMA A ell
TECHNICIAN: DATE COMPLETED: I � ° -+�' 41 • a y 0 TRAVEL: S
t354
SIGNATURE (1 hereby acknowledge the completion of the above described work) PAY THIS AMOUNT:1 LA Z-G
X
Tha Yo • , e Appreciate Your Business!
1