Permit CITY OF TIGARD SEWER CONNECTION PERMIT
1114 COMMUNITY DEVELOPMENT Permit#: SWR2020-00187
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/16/2020
Parcel: 2 S 103AC03000
Jurisdiction: Tigard
Site address: 12480 SW 112TH AVE
Project: repair sewer service Subdivision: MCMICHAEL HEIGHTS Lot: 3
Project Description: Sewer connection for existing home. Septic tank to be pumped and filled.
Contractor: Owner: INGALLINA, CHRIS&TONI
2764 N GREEN VALLEY PKWY#254
HENDERSON, NV 89014
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/16/2020 $5,800.00
Sewer Inspection-Residential 12/16/2020 $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 5 .232.1987 or 1.800.332.2344.
Issued By: r / Permittee Signature: ,ter P9-7-1/6 / C'et-j-76/A /
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.
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t, t04-/-7 .1,14 6AI/77-els 0A/4:-/iv
k Plumbing Permit Application / 1",e'l-/64-re,,/ /2, -.7 :6 /:--e-rz_ -.S o_)/2_ "es724-1/7- •
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t Budding Fixtures FOR MIAs: 'l USE ONI.T'
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'.... City of Tigard Roc.cury: /:91/7,32(R)."--- lk*rmil Nel: i1/177/e),e-eo7
, 1,144 ,. 13125 SW Nall Blvd.,Tigard,OR 97223
1 2 Phone: 503 718.2439 2'am 510.5a81960
Inspection One: 503.639.4175
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Internet: www.tigard-or.goc P11115 Re‘itnt,
Datemy:
Bate Ready/By:
NotiticaAirthati. 01 he i /til ii Na..,...._(.13)'t 1.. n ‘,1L
hue RI Sec Page 2 for
H---"....,<- , Suppirmentat infortnadon
j'6 6A2 brii•
TYPE OF WORK , FEE* SCHEDULE
0 Nctv construction
X,Additi on alteration/replacement
0 Demolition
0 Other. 'Description Far special information use checklist.
I Qty. j Ea. 1 Total
New I-2-fam113 dwellings(includes 100 II.for each utility connection)
CATEGORY OF CONSTRUCTION ' ' SIR III bath 312.70
I-and...-laini I y dwelling
0 Clommerciarindustrial SFR(2)bath 437.78
1
SFR(3)bath 500.32
••• 0 Accessory building
[3 Master builder 0 Other:
t 0 Multi-family
IFORMATION AND LO CTION Fire spiinkles( sq.It.)
SEIlltcc uhatidlt additional
bultilkitchen 25.02
Page 2
JOB SITE N
(
.."‘" Job sac address: V2i...\50 C...A.k. \\IAN-, ?" Catch basm or arca drain 18.70
vs .,
lkywell.leach tine,or trench drain I 8.76
City/State/ZIP:11.+RA t c ovi .2:19„
Footing drain(no linear ft.: ) Page 2
„It Suite/bldg.apt.no: Project
lutine: Manufactured home utilities 50.03
t.Cross stree directions to job site: Manholes 18.76
Rain drain connector 18.76
'Sanitary sewer(no.linear ft.:503 1 Page 2 (02 60 Storm vewer(no.linear ft,: ) Page 2
Water service(no.honor IL, 3 Page 2
S Subdivision: Lot tot.: Fixture or item: ,..
lax map/parcel no.: Backilow precentor 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
a•rs, , x , Clothes washer 25.02
\X e,,DVONYVVSc--)itIC\ USSVPitk, C‘...\\ Nilk ki...) Dishwasher 25.02
catv\Ps VI\k- -'ct,cil QIYA 4 CrlCSIV tO Z2VV1.5 Drinking fountain 25.02
i kckbcm v't.,k. Ixtpc'VV4VIC7) Ejectors/suing 25.02
.si El PROPERTY OWNER 0 TENANT ' Expansion tank 12.51
Ntune:
FixtureNewer cap
Fleur drain/floor Sink/hub 25.02
Addres
Garbage disposal 25.02
25,02
s'
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
a-APPLICANT 0 CONTACT PERSON Interceptot/greahe trap 25.02
VAS Q.. e,,,,...sp,-,-,i._
( Contact..., orkk ttk, 1(kicA\S-Ick..06 Medical gas(value:S )
Primer Page 2
Business name:
12.51
SC Roof drain(commercial) 12.51
.,.... Address:
<l, Sinklbasirvlavatory 25.02
s. City/State/LW: Solar units(potable water) 62.54
-}..,, Phone:( ) Fax::( ) Tuh'shower'shower pail t 2.51
Urinal 25.02
E-mail:
Water closer 25.02
CONTRACTOR
Water heater 37.52
r"
.'"1, Business name:klARi..,ytkitc, St iAly.s c.; \Prater p iping(DWV 56.29
s.. Address: lf.,\V1/42(501 e., C-tic:ifc,Aik C4., pow) 29)3 _
Other: 25.02
(ley/State/ZIP-%/-kkeuritii„or cki 126 ..bbry\4f%Li woo Subtotal
(56;6 aso .sc.' R i , .,,,, „_,_ ,,,-,
Ver-,7 LIV110)'I ell-k Minimum
permit fee: S72.50
Phone: )e i
Plan review (25%of['emit fee)
CCB 1 Ic,: rj..,\QA g\-) ,,, .,Plunthing Lic.no.:kiCt t
State surcharge(12%of permit She)
Authorized signature: TOTAL PERMIT FEE
{Print name .1 Date: 1312 0 This pernilt implication expires if*permit Is not obtained within-10days
after it has bmn accepted as nomplete.
9 m..otuthudology set by tri-Courty likOkhng Intitutt y Serowe thriird.
I.11.11<ling.Pennti,,PiAlt-PconitApp.d.t. 111/01 09 4,40-V•1441141,•fa(1)WW1,1f)
Branden Taggart
From: #Building Permit Technicians
Sent: Wednesday, December 9, 2020 5:42 PM
To: Keith Reynolds
Cc: Dianna Ornelas
Subject: RE: 12480 Sw 112th Ave - Plumbing/Sewer Permit App: SWR2020-00187
Attachments: 12480 Sw 112th Ave Plumbing Permit App.pdf; Sewer Permit Invoice.pdf
Chelsea,
Thank you for the Plumbing Permit Application. I have created the Sewer permit, and the balance due is$5,835.00. An
invoice is attached above for you to reference. The permit fees can be paid online through our
website: https://aca.accela.com/tigard/Default.aspx. From there, click on the Building tab, enter the permit number
(SWR2020-00187) in the Record Number field, and click Search. Once paid, please notify us at
TigardBuildingPermits@tigard-or.gov, and we will email the permit paperwork to you.
Please note that I have placed a hold on Plumbing permit PLM2020-00487 for payment of the sewer fees. Once the
sewer permit fees are paid, I will remove the hold, and inspections can be scheduled.
Thank you,
Branden Taggart
III e City of Tigard
1i s Senior Permit Technician
Community Development
((CARD
13125 SW Hall Blvd
Tigard, OR 97223
(503)718-2449
brandent@tigard-or.gov
From: Keith Reynolds<reynoldssewers@gmail.com>
Sent:Wednesday, December 9, 2020 1:58 PM
To:#Building Permit Technicians<TigardBuildingPermits@tigard-or.gov>
Subject: Re: 12480 Sw 112th Ave - Plumbing/Sewer Permit App
Caution! This message was sent from outside your organization.
Hello,
Attached is the completed application, let me know if anything is missing.
Thanks,
Chelsea
Reynolds Sewers Inc.
503-913-2328
11954 NE Glisan ST
PMB #233
i
Portland, OR 9722o
Reynoldssewersa gmail.com
On Wed, Dec 9, 2020 at 1:55 PM #Building Permit Technicians<TigardBuildingPermits(catigard-or.gov>wrote:
Hi Chelsea,
To reiterate our phone conversation on Monday, once you are able to email a completed Plumbing Permit Application,
we will be able to create the Sewer permit and invoice sewer fees. I have attached the permit application above for
you. Please let me know if you have additional questions.
Thank you,
Branden Taggart
a City of Tigard
, Senior Permit Technician
Community Development
13125 SW Hall Blvd
Tigard, OR 47223
(503)718-2449
b randent''ti gard-o r.gov
From: Keith Reynolds<reynoldssewers@gmail.com>
Sent: Wednesday, December 9, 2020 10:33 AM
To: #Building Permit Technicians<TigardBuildingPermitsi tigard-or.gov>
Subject: Re: 12480 Sw 112th Ave- Plumbing/Sewer Permit App
Hello,
I'm following up on this Permit application. We purchased a plumbing permit online, but need the permit to cover the
decommission of a cesspool.
Plumbing Permit#: PLM2020-00487
2
Let me know if you have any questions or concerns.
Thank you,
Chelsea
Reynolds Sewers Inc.
503-913-2328
11954 NE Glisan ST
PMB #233
Portland, OR 97220
Revnoldssewersna gmail.com
On Mon, Dec 7, 2020 at 2:12 PM Keith Reynolds<revnoldssewers@gmail.com>wrote:
Bra ndon,
Thank you for calling me back today, attached is the permit application to process.
I I appreciate the info today, if we have another septic decommission project in the future we will reach out to this
email address first to start the permitting process.
Let me know if you have any questions.
Thanks,
Chelsea
Reynolds Sewers Inc.
3
• • 5o3-913-2328
11954 NE Glisan ST
PMB #233
Portland, OR 9722o
Revn oldssewers(a)gmail.com
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-
mail may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are
retained by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention
Schedule."
4