Permit CITY OF TIGARD SEWER CONNECTION PERMIT
11111 ■. COMMUNITY DEVELOPMENT Permit SWR2020-00181
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2020
TIGARD g Parcel: 2S103BD02100
Jurisdiction: Tigard
Site address: 11805 SW CARMEN ST
Project: Sharp Subdivision: CARMEN PARK Lot: 10
Project Description: Connect existing detached dwelling to public sewer.
Contractor: Owner: SHARP, JEFFREY W
11805 SW CARMEN ST
PORTLAND, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/10/2020 $5,800.00
Sewer Inspection-Residential 11/10/2020 $35.00
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,835.00
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: IS A v 4ry Permittee Signature: On CAM
iC-441
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.
I'IumIiin : Permit ApplilTit7 CFIVE(`l 6 - 10l2 - c
Building I I\turc% �°
Ott or l ig «'(i OCT 2 6 2020 NrccnrJ ii 5/2v .410 . TM�^°", PLrt 2 u--doLi l 7-
nbldtl`
u t.l:>.w is,. Ilat.aJ 'x't r �(),,,
14 . 4 'It zr1" Fa, n ,udF TI i oft `� eats fc ml u I` _(/LI
hn{xrnun1tac (nthlyalt 11LDiN0 DIVISION • __. ., __ .__ . I,�I;
1{GAI(17 xc�>4t i 4• � SYr 1 r.L.
Intrnuti xwx Itprn9-uc.tn, " I.dM4.'•I -3/� •G1.
_.. ._ _..__...„ __._.r.._.__._..._.,._ ... Srpylhv.tretal lnf.rttrlaawn
11'PF- 01 35011k if//,.- b 4 11.1• SCHEt)t1.1.
❑NO% c..n.trua, ❑1k100.11110( _ _ 100 timeat SJOtnemSnf n.e(Om flrtc
pescnputts I (j r_,.._1-a 1--lutal
,Adthititm a)tcratxm'rcptuenvxno 0 thtY Neu II-2-hulk dwtIlinRt lmchtdc- 100 0 for oath outtluu tc i un)
CATEGORY OF CONSTRUCTION SFR 11 l bal'. 312 70
LJ-ukl 2-Guni,y dwelling 0 1 ornately indtnlnal SFR i2)ham.. .,, 43771
Acem ry tnp 0!hulls-tamity SFR 13)bats Ste'}:
huild
Each«Wnranal total ktayr 25.02
❑Master builder 0 CNhcr I ire sprinkler Ier.?.I 1 Past-'..
JOB SITE INFOURIATI0 AND LOCATION Site ut)Ntres:
Jub sit addrns: 11 W o5 S.w c A4-1�1e,N_s/_ (ak•h basin at arts thaw - ilk.76
v 1Uryncll,leach line.or troth tkain l a 7b
C'rty/Slate'LIPr�,Ja p*•, r,xting dram t,en.linear tt, ) Page 3 i
Suite 4i).apt.tK : Project Mine. Manufactured haste ulihtns 5091
OURS wort directions to lob site: Manholes 1%.76
n(t)7-6- ',.. ./4 Ql/ Psi UT) 61Jr.-I"J�`i 6 y Rarndnenwnnsrtur 1076
CON".r v\ e r''7T)2_ -C� 7 41.5 aim e Li Cal non) Santos o Cte&e o l Ftncar ft: l Past 2
IS 1 (l P 0-0CV-3"s £'1L✓;- COA)Jd6-�TW,ti SWrrnarualnu hnllear i pa94' I
Watrr w'n ac MO knew 11 ) � ' Page„
So/nil stspal Loth" Fitter,orbour
IJt nup;'pan'rl iv
ptewat 31..27
Fiatiwalcr t alse 12 31
DESCRIPTION OE %ORN
-. (lathes waist, 23.02
v te•rooNe. 5gwt•U, . so.aor4cc" set\14.ito.N.ko , frahwnshn :S.u2 '
C,N1t3 Mati.A 1es i'O W V5o �ttse " rsJk ...._. . Ittn►nyt1 ntnin 23.02
\ Ejelcare s p 23.02
[] PROPERTY OWNER 0 TF\A\T I'. psnwtmtank 12.31
tiann F'ixnrNaswcr cap 23.02
Flow*monocle-stalk/bob 23.02
Atldrt,, (hrrbage d,tpowel :S tr2
('ny'Statc LIP: flow bib 25.02
Ph,„; ; ) Fas.l I kcrtukcr 1251
APPLICANT 0 C'ON1At1 PLAS1ON Intertgiiagteaschap 25.02
Medical SaA-oa4uc:S__) P•rfie 2 .
Pruner 12.51
1°ills((nimr. - -
Rml drein(tomarnia) 12 51
Adttl s... Sink town layaway 23.02
k.O tuy;St:o w i i r ._ %silo.units(r table swat?) b2.41
Phout I 1 I Fae.•( ) Tub'Juowa'srwtr pm 12.31
�Urinal 25.02
E-rtmd:in;Co€A3\%CI+r ec.lco �c%+-ovol• _"
- W'atet dose 23.92
tot 1kt( 1110
D i t , (i� � � V st 000 17.52
it
Itresuw^+,r_u'` AGlfs g,.0 C� \,J Y\�,IC�trs09MS f l•'V�r ‘a tee plpiesOlk V 56.29
Addrts.iatp_) Ne,_ +N-1v. p\ VV _ Other: 23dt2
1kOAdAsoro o 1. (Vi'9,4 Subtotal
c ny stat'rIP q
Thorne:(�v5 ) 144 1 , t 5 Is, lat.) ) Minimum permit its.. $7:.50
_._._. Pam resicw 23'.al
et'1O I a.,. ` 1 tP l l Plunohirtg I k.rn.:1%M 55 • t• Knoll for) 1
State mcharYe F 12•.i,of permit roc)
lmhlrvrivimA1:rr r 1O104P1kMI1Ft!
�• fL T ' tL�Ly . . . naoc. IDIMPIV.0J permit per. apaltadw m"tra it awtu p111s as abtalool oldie lM Gas
J it snot it kaa Iwo attepnd as ror+kM.
•I r...-a:.lwaoloq Po 14 t tttetoitar iruiffldatr 111dwM1)kill ire I Wald.
aaa.4htSI,IIPR:tram w t III
PlunihinL Permit Annlication - City of Tigard
I'age 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities ay. Fee Irma Total Square Footage: Permit Fee:
I.d.r r,_dram- I'too' 30-03 0 612,000 S 12i mi .
rnt,',nj;damn-ca.ln oddnnntal 100' 17,52 2,1t0f to 3,60at 514464
3.601 to 7,21nn --- ..__ 5233.20
SrNer- Iat loll' i 62.51 GZ43, 7,201 mdgrr,ost S'7'*t4
Stahel•catch addfewnal IOW 37.32
wuhr Scnd.v- I.s I110 62-34 Medical (ias Ss sterns:
Stoke Se-each additional I tar 37.32 -
SIMm&Rain Moo- IN Irma ,.,S.l Valuation: t Permit Fee:
TSI.t7tl ha 95,0allx1)0 Mwmmun tes 57330
SU+mn&Rain ikon-each addttiuorl 100' n' +.' i 55.001.twi 10 S1011110 00 S72 50 roe the find$4.0n0.00 and 31 12'a.
Other Inspections or Fees ony• Icons) Tidal eaehAddan>rulSi00 Moe tracliotMeirya u,
i!e , and including 510,000 00,
Insl.;•criun.•t r+r.un}i•i,indn ni•tlr l.r S EOM 1 00 to 52SJtlx0.00 S 14It.10 tar the fint IIO.0Ot1 fl0 and S 1,5.1 for
ninth no tee ix spnifnraily indwaled 41 I I hi each adfail sI0000or fraction theresit•in
nrinimumcharge- 1'2luatt> and irtelydina523,00000,
Inspections nut+ttk of nomad businc+s .111,r,ill $23,001 00 to 550.000.00 S379 30 fie the feu 5225.000.00 and S I.15 for
boonlrraarndurtichrlg. ?Mt:r.t caninsoot:,.nit310 uoiefractionthereof,lu
Rearnrc+snon rem ... "u,at in and nrtrits ^,..000.00.
&adman-al ohm 11:1n.u :•nuat+r,n„ 55u001.Onandap S71'tr+I. II. .,M$50,0DflOiladSl.20 for
lmintmum charg:—I'2 hour) I to :� .L!. ,., s 100:00 or fraction there d.
Sutgalal, _...1.
Commcrci:il Fixture Vi'ork:
Are you capping.adding or replacing fixtures:' If"yea".
please Indicate work performed by fixture. ',allure to
accurately report ftclurcc could result in increased tester fees*. Plan Review for Plumbing Installations
Quanta!)hi I-lslurs, I ypa Plan review ne required lot.nth of the Itclluwnnf;,
rltrrre 7ipe for arpi . Please check all that of ply.
%ar►Pritorined: t"rplyd .5ddrd arkraa
Winona.ion' CI Any new commercial bunWing with water scrvxe 2-and
Ipcatcr.cap,�it sy-than.desired and stamped by l-acenscd
Nair I u1+Showrt
in tit ecr
t..rom Wlartp"'.` 0 Ncw exterior plumbittp site utilities fur any complex strv.tute
for N'a+l, I Stall as defined in° M9l*i-7110•404U.
-(hive ltuu
t 11,11001 NA. A>pinnur - 0 hkdiral gm.and+acuum sysetnts tor health can:fatcililKs..
....I. t nrrmomrocrcial ❑ Any mtiltiptupnar fire sprinkler system
tr„h tk. El Any contpkx structure ut defined in UAR91 h-71itFtlt 11.1
lkonoi
1-yr tint Su honk j acts ar pleas ionth any of the'Mite.
Floor Ilratr..u* +
• Isoturtric or Riser Diagram
1 U lt. socfric rn rive,iii.rr.nn i' ic.iulrid liar n,2+i huildiU}!h
d'ar wash[NAM
tiarhtgc •ihaaeuic non-Gaul Ilan ntiC1 ihc.ilu•t11G..ni,a ^.rhn+¢.
Diaparaf -UdnntvI.e bud rclatcd
-Commercial food retied
-ladWailat food Mated
ntach;Rrfrig.Drams Comments regarding fixture work:
oil Separator(lia.Station) ^.
Ric.5 rho►:llrav Swaim
Shower -/ding
Stall •
Sinn& -Um,Iiii Icon-tdx,d iitall+(
-fsradicT
-ComSen/Utd find rebored
-ticr%ICC `\one: It the fixture+suck under this permit results in uu
Swinming Pool Finn Increase of scare Faltis,a u•n er permit will be issued and
U'asher-t dares
Water F.xuarutr fees assessed for the scsier iucreasc must he paid before the
Wake Closet-tokt plumbing permit eau be issued.
Urinal
Other Fixlvea:
t:ittudtling PcrrnitiveLMI-_l'crmttApp.do a OP O4'2011 2
RECEIVED
OCT 2 6 2020
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT CITY OF TIGARD
• BUILDING DIVISION
Reimbursement District Payment Worksheet
TIGARD, 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 • www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing 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: 11805 SW Carmen Street
Reimbursement District #: 25 Parcel
#:Amount Due: $0.00 Amount Due Expires On: SRD Expired 6/9/2017
Applicant: Daytime Phone.
Email Address:
n Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee,if applicable)*
By: Maw Quach' Date: 10/12/2020
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ Receipt#:
SWR #: PLM #:
Enter parcel conditions in Accela (check all that apply):
❑ Enter "paid" condition.
❑ Enter "deferral" condition,if applicable.
By:
Date:
Name
Printed:
Attach this worksheet to issued sewer permit for records scanning.
1:\Building\Riembursement Districts\ReimDistPaymentWorksheet_NoDeferredAccounts_041918.docx