Permit CITY OF TIGARD SEWER CONNECTION PERMIT
"1 '' COMMUNITY DEVELOPMENT Permit#: SWR2022-00059
Date Issued: 5/25/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel 2S103CC01800
Jurisdiction: Tigard
Site address: 12000 SW ROSE VISTA DR
Project: Sewer repair Subdivision: COLONIAL VIEW Lot: 13
Project Description: Sewer connection for existing dwelling. Septic tank to be pumped and filled.
Contractor: Owner: ESPY, BRENT E& GEORGIA L
12000 SW ROSE VISTA DR
TIGARD,OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/25/2022 $6,085.00
Sewer Inspection-Residential 05/25/2022 $35.00
Type of Use: SF
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $6,120.00
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 expir- work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you • f• ow the' rules by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You stain a copy of les
Issued By: ermittee Signature: .� ` �l
C 50 .639.4175 by 7:00 a.m.for the next available in-section 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 RECEIVE I FOR OFFICE USE ONI 0
Rcaived
•
City of Tigard Date/BY: V" Permit No.: 2^&, -
111
• 13125 SW Hall Blvd.,Tigard,OR 97223 spy 2 5 len J or7 7 y
Da Review Other Permit No.: 9 ]4 c)l,•
Phone: 503.718.2439 Fax: 503.598.1960 y r (/
Inspection Line: 503.639.4175 . Date Ready/By Jails: ® See Page 2 for
T'�^'��' Internet: www ti srd-orgov CITY OF TIGAR[7
�• ad Supplemental Information
%TYPE OF • a, " u Isa 9/1 �<E r 'it's FEE* SCIIEDLI F
❑ ew construction ■ . . For special infarma[ion use checklist
Description I Qty. I Ea. I Total
[ Addition/alteration replacement ■ • , New 1-2-family dwellings(includes 100 ft.for each utility connection)
f CATEGORY •,•,sae �„ i su• - SFR(1)bath 312.70
L 1-and 2-family dwelling 0 Commercial/industrial _ SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION s.p Via+• ,L 4-°,,A- . .Sf,..~ ;• Site utilities:
Job site address: t 7 cvoo S't4) y✓05Q U l sl , t• r basinCatch !
Drywell,leach line,or trench drain 18 76
City/State/ZIP: -t-(3 4t.A O
Footing drain(no.linear ft.:____,) Page 2
Suite/bldg./apt.no.: Project name: rj f:' Manufactured home utilities 50 t
Cross street/directions to job site: Mardioles
Rain drain connector 18.76
,Sanitary sewer(no.linear ft.: ) Page 2
Subdivision: /r C•o [.(/V - _ ..X�I.ot not
Tax map/parcel no.: 44.44,,,_,fBackflow rcventer ®�
ESCRITr � t ,a;e a z nw ,eA
it., clothes.orashl„ 25.02
T�_C oc,.-t�. S a.e...�(2-s co PI La e-ct ;to 0 its Lt y Dishwasher 25.02
SeL..,es- Drinlcing fountaint
• 6 ' ' - ! .f -s%/s/0)s7, t
rROPFttTY OWNER , . 9 TENANT "' '£, ) Expansion tank 12.51
Fixture/sewer cap t
Name:
Floor drain/floor sinldhub 25.02
Address:
disposalGarbage t
City/State/ZTP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPILCANT ❑ CONTACT PERSONInterceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: C; 1\1 e_trie,404, _7(sCO3-.0,-/ t,'u
Contact name:
Roof drain(commercial) 12.51
Address: i
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fox ( )
Urinal
E-mail: i
Water closet t
` CONTRACTOR
Business name: 0 IA, 10.¢,yv1.0.010. err-C6-1.)C -k\0 i Water,
Address: Q o Q e'X (,(% Z Other.
City/State/ZIP: tui,(wTlr, oe 117�(„z- Subtotal
Phone:(''7( ) Z7c 4-!4/ 3 Fax:( ) Minimum permit fee: $72.50
CCBLic.: Z( 6- sg Plumbing Lic.no.: P "_LC(4,7 Plan review (25%ofpetmitfee)
2•,
State surcharge(12%of permit fee)
Authorized signature: ^J TOTAL PERMIT FEB
Print name: •k oy Date: 'L ( Thh permit application expires if a permit is not obtained within 18e days
G •S tn^ a S I SI Z-7_ after it has been accepted as complete.
°Fee methodology set by Tri-County Building Industry Service Board.
I:Vauildine\PermdsVPLM[l-PermitApp.doc 10/01/09 440-4616T(l 0/02/COM/WER)