Permit CITY OF
TIGARDARD
COMMUNITY DEVELOPMENT ENT` ' PLUMBING PERMIT
t#:
PLM2016 00123
f GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/08/2016
-T
Parcel: 2S109AB04800
Jurisdiction: Tigard
Site address: 14244 SW 134TH DR
Project: Goodman Subdivision: THREE MOUNTAINS ESTATES Lot: 41
Project Description: Replace approximately 5'of sanitary sewer line in private easement.
Contractor: ENVIRONMENTAL WORKS Owner: GOODMAN, LAIRD MICHAEL&PAMELA
2634 SE STEELE ST GOODMAN REVOCABLE TRUST
PORTLAND, OR 97202 14244 SW 134TH DR
TIGARD, OR 97224
PHONE: 503-719-6715 PHONE: 503-579 4012
FAX: 503-972-1866
FEES
Quantity Description Date Amount
5 If Sanitary Sewer 03/08/2016 $62.54
Specifics: 1 12%State Surcharge- 03/08/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 03/08/2016 $9.96
Plumbing
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 . . _-nter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
o .erect questions to O► • .-fling 503.232.1987 or 1.800.332.2344.
Issued By: 1///.44 .1—;
/ 1i Permitter Signature: Oda/27W
Call 503.639.4175 by 7:00 a.m.for the next available in .ection 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.
Plumbing Permit Application
Site Utilities �,� FOR OFFICE 11S1'. ONL '
Received Permit No.:
City of Tigard Date./By: /G �L�/lolly—Cbl-2 3
• 13125 SW(tali Blvd.,Tigard,501 ) plan Review Other Permit No _
III Phone: 503.718.2439 Fax: 503 `L116 T)nte)By:
ViCARD Inspection Line: 503.6)9.4175 MPt� Q DppptcRend)!I3v: )iris. 1 See Page 2for
Internet. www.tigard-or.gov \`t\ ified/Hollow Supplemental Information ,
. " ' ,. TY-0 OF t��.ti " - 0A SItS .: FEE* SCHEDULE •
❑New constnlction 0 ` \`� - For special information use checklist. _
— a �---•--- i I Description I Ory I ha. I l
EJ Addition/alteration/replacement ❑l3il)er: I New I-2-family dwellings(includes 100 R tit each utility conncetnip i
~CATEGOR's•OF-C RI TION SFR(I)bath ---— --- +12 7!t
SFR(2)hath T417 78
® 1-and 2-family dwelling El Commercial/industrial 'F.: ..__.,.-,-_ _ _ -a-.... _ .
„I i
Si'R(3)bath i 500,1
Accessory building ❑Multi-family t
_ ._., ___...•_,._ f ach additional bath/kitchen 25,0'
0 Master builder Q Other: ~I ire sprinkler(______sn.fi) j Page 2
JOA.s1TE.,N ORMAT'I(�pF-AI')1 L4 `tt.TIO1sI ,•--•� 1 Site utilities �- R-
Jib site address: 14244 4W 134`7 Ave Catch basin or area drain 18 76
_,-_._.-------.••____--..__.•.___ I I l)rywell,leach line,or trench drain 18,76
Ci--- tte/Z-.---*:Tigard _ Footing drain(nn.linear ht I Page 2
Sulk,bldg +pt.no.: Project.name:: Manufactured homeutilities 50 0
Cross street/directions w job site: I Manholes18.76 i
Rain drain connector I 18.76I
t t
--._.._---_- _T--— ___— -__._-_ _._ _a_.___.-__-_ 1 Sanitary server pro linear fl. I I've' r .,,,
,.-----------------------------------.- ..-,_------,-^,1 [-Storm sewer(no.linear 11.-: i - . Pege ,
- -T _ I W ter service(no.linear li __,) . Page7
Subdivision: I 1.at roa: t ixture of item
i a.<n)ap/parcel no.: 1 Hucktlaw preventrr 31._
Li - DESCRW. 1ON �?F WORT{,r -�— I Backwater valve ---- _ 12,2I
Clothes washer 25.02 :
Replace a section of sewer behind neighbors property in easement -----
W)-__ -._.--__- _ _-._.-_,__ _—..___ I Dishwasher 25.02
__ Drinking fbmitain -2i tl ;
-
444111— of tank ,
1 Liectorsiallfp T ,5.02
W I-.-. ❑ PROPERTV,30.WJVER. j ❑ T N. N1 xpa t -. _.__ 12 S
r na
'-- I i lxtureiso er cap 25.0
amc: Pamela Goodman -- •
.___._.._,.-..—_,-.
--- --•..- _. ----- LI,Mor drain/floor sink/hub I 25 )2
i ___._.-__-
I- Address: 14244 SW 134`)'Ave - - -�- --- -- -- 4
.—.. .,- -..-_--_.,_. _— _..-_._-_ (,arbagedisposal 25.0
2 i
-' i ity:Stale/71P:Tigard 0R 97224 Illostbitt
_
- •T - 1 25.02
�. Phone (503)579 4012 Fax:( ) - I Ice maker ._-----_-_-, 51
-
Q r�P I:I ►h"F .;,. EC1M i Ai, f �`k RbO ti I .. -- 2 i 0' r_..
°.,i �nterca:pturit;rea;c trap 1-
-r
i Medical gas(vatic:S 4) � Peg)_2 i
Business name: ,-
Prilner ( I 12 51 I •
(Contact name: - •
- _-_._.-._-__-,-, _—,___ __1 -..__.._..._, i.
_•-,.--_,-_-_-_--__.._— Roof drain(commercial) 12.51
Address: - �..__._.___ _ �____ {
Sinkibasin lavatory 25.02
ljtr7tj'k--14rt4k—
I Solar units(potable water) _. i
Phone:( S a�3 -7/ 17-- i? ax::
` ( ) - — - -i Tub/shower/shower pan - _- 12.51
I
F-matt: t C oork5 NIA).Co/y . I'rml -- _ 5 02
—-- - • _ .�- LWalel :Inset _
CONTMRCIOR ._.--__,-,._----_.-.-_----�
1.�.. _ /7.,1
._,._ Water— , Water heater
Business name: E-Works ;
----- - - - --
__-. ----- 11h-aicr piping/DWI56 29
Address 2634 SL Steele St Other: - - _ i 25 0'
I C lit•.Statei7.,IP: Portland OR 97202 jSubtotal
__
Plum) (503)467.93:• ;rim( _ ) i Minimum permit IleS72 50 1
r- - - Man review (25"/0 of permit fee)
t( l'.i Lie.: 185781 ___ Plumbing l,ie,no.. __- � M1 �--------_.__.___,_._. __.-_ _ ___.,.,__
- Slate surcharge(I 1%ofpt-twit len) ' g7C'�
Authorized �"'~- - - —• 'It)I Al PERMIT I (Ll 1rcJ� , ..:
_ _.-_._.__._ y._
Ryan '--__ -_-6 -` This petmil appho atino expires If a permit i not oboaincd Hthin 155!la...s
Print name: rleycr DPW:03/(17/2016
_� after it has been accepted as complete.
"Fee meiliodiingy sot by Tri-County Building Industry Servi.'e li i i..1 J
I
I';.l},Iildinh Pc:ol%iI-Mll-PermiIApp.dee Iildil/09 4-0h.to i c'r(IIII jCOM:,i:ti}
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14244 SW 134TH DR, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00123
Don Sylvester
1. Repair San. Sewer line located in easement. ( inspection by video )
Violation Summary:
Inspector Contractor