Permit CITY OF TIGARD PLUMBING PERMIT
114
a COMMUNITY DEVELOPMENT Permit #: PLM2012 00203
T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/24/2012
Parcel: 25111 CB01738
Jurisdiction: Tigard
Site address: 10400 SW HOODVIEW DR
Project: Chwirka Subdivision: HOOD VIEW NO.2 Lot: 37
Project Description: Connect existing house to sewer service.
•
Contractor: TCJ CONSTRUCTION Owner: CHWIRKA, STEVEN A
19750 SW PAGE CT 10400 SW HOODVIEW DR
BEAVERTON, OR 97007 TIGARD, OR 97224
PHONE: 503 - 320 -7831 PHONE: 503 - 620 -7777
FAX: 503 - 259 -2432
FEES
Quantity Description Date Amount
60 If Sewer Service 07/24/2012 $62.54
Specifics: 1 12% State, S urcharge - 07/24/2012 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 07/24/2012 $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 N. - cation Cen • . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or dir= t questions to OUN ► . ailing 503.232.1987 or 1.800.332.2344.
Is ued By: 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.
Plumbing Permit Application
hlitieS FOR OFFICE LSE ONLY
ECE';ED l City of Tigard �e/a 7 O f / t , / Permit No.: Vije/�{ e0o9J3
13125 SW Hall Blvd., Tigard, O 9�'�223) I,1 _ r
IN ' 31 I � 21� I Z Plan Review � [, _ A /0 �Q . 7
Phone: 503.718.2439 Fax: 50 598.1 Other Permit No. ( ( Q
Date/By:
T l G A R D Inspection Line: 503.639 rr. t., Date Ready/By. kris. ® See Page 2 for
Internet www.tigard- or.gov CITY Ur 1 ! ,-. a., Notified/Method: Supplemental Information
TYPE Ol)J 4 KK'! )...a + -•j lV FEE* SCHEDULE
❑ New construction El Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ® Other: swr connect New 1- 2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1) 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
El Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
El Master builder El Other:
Fire sprinkler ( _ sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10400 SW Hoodview Drive Catch basin or area drain 18.76
City/ State/ZIP: Tigard Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldgiapt. no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Sanitary sewer connection to public service
Dishwasher 25.02
Decommision septic tank Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Steve Chwirka Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 10400 SW Hoodview Drive
Garbage disposal 25.02
City/ State/ZIP: Tigard Hose bib 25.02
Phone: (503)620 -7777 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: TCJ ConstructionCo., Inc. Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Troy Jewell
Roof drain (commercial) 12.51
Address: 19750 SW Page Ct. Sink/basin/lavatory 25.02
City/St ate / ZIP: Beaverton,OR 97007 Solar units (potable water) 62.54
Phone: (503) 320 -7831 Fax: : ( ) Tub /shower /shower pan 12.51
E- mail: tcj.construction @yahoo.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: TCJ Construction Co., Inc Water piping/DWV 56.29
Address: Same as above Other: septic decommis 25.02
City/State/ZIP: Subtotal
Phone: (503) 320 -7831 / Fax: ( ) Minimum permit fee: $72.50 '7A .S U
CCB Lic.: 67499 �/a37�/ Plumbing Lic. no.:
State surcharge review (25% of permit fee) 70
111 ( urcharge (12% of permit fee) $-
Authorized signature:N M-. ------------ TOTAL PERMIT FEE ,Ti a )
Print name: Troy Jewell Date: 7 -2412 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.