Permit CITY OF TIGARD SEWER CONNECTION PERMIT
kt
s. COMMUNITY DEVELOPMENT Permit#: SWR2022-00049
Date Issued: 5/25/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S102BC04000
Jurisdiction: Tigard
Site address: 12790 SW WATKINS AVE
Project: Schmidt Subdivision: NORTH TIGARDVILLE ADDITION Lot: 31
Project Description: Sewer connection for existing dwelling. Septic tank to be pumped and filled.
Contractor: Owner: SCHMIDT, LOREN M
12790 SW WATKINS AVE
TIGARD, OR 97223
PHONE: PHONE: 971-506-5981
FAX:
FEES
Description Date Amount
Specifics:
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $0.00
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
---ErIssued By: Permittee Signature:
C 3.639.4175 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.
.1
Plumbing Permit Application
Building Fixtures RECEIVE
/ I OR OlER E: ( su: ON►.v
City of Tigard Date/ReceiB. "/�I P" 4 ._ Permit No: 5: 2® 1+11,nw�
- a 13125 SW Hall Blvd.,Tigard,OR 97223 Y ��V/Osl�
q Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ZOZZ Date/By: Other Permit No..r i?on__do 1
�P�t2� V IC/u
TIGARD Inspection Line: 503 639 4175 Date Ready/By:/B tuns. ® See Page 2 for
Internet: www.tigard-or.gov ,�'. Notified/Method: Supplemental Information
TYPE OF WORK ,x l .t FEE".SCLLEDUI.E
❑x New construction ❑ Demolition For special information use checklist
Description I QtY. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312 70
0 1-and 2-Family dwelling ❑Conunercialiindustrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath kitchen 25.02
❑ Master builder ❑Other: _ Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 12790 SW Watkins Ave
Drywell,leach line,or trench drain 18.76
City/State/ZIP: Tigard,OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Schmidt Manufactured home utilities 50.03
Cross street/directions to job site: SW Walnut St Manholes 18.76
'.4y4 S,.�y�,� Lt� NFL `,' 1044
Rain drain connector 18"76
-� i r" 1�' Sanitary sewer(no,linear ft, ) Page 2
f n
Cullom-" I. el -"Pei it {4 44Storm sewer(no.linear ft.: ) Page 2
Ld4,j 1/-esa YU cee�.�C C+m'^I 1 I Water service(no linear ft.:_) Page 2
Subdivision: 'frlL3 L.JerC fJs`»i tKs Lot no.: Fixture or item:
Tax ma ucel no 4,- e. Jt, ��. 'ackflowpreventer 31.27
pt- t)tf !'7<rs1A'-� a t.a ;
ackwater valve 12.51
DESCRIPTION OF WORK - - 25.02
.. - Clothes washer
Please add a sewer connection permit to the existing plumbing permit PLM2022-00122. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
10 PROPERTY OWNER... ❑ TENANT .. Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Loren Schmidt
Floor drain/floor sink/hub 25.02
Address: 12790 SW Watkins Ave Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:( 971 )506-5981 Fax: ( ) Ice maker 12.51
0 APPLICANT'W ❑ CONTACT PERSON Interceptor/grease trap 25.02
--- Medical gas(value:$ ) Page 2
Business name: Alpha Environmental Services 1251
Primer
Contact name: Erick Gonzalez Roof drain(commercial) 12.51
Address: 11080 SW Allen Blvd,Ste 100 Sink/basin/lavatory 25 02
City/State/ZIP: Beaverton,OR 97005 Solar units(potable water) 62.54
Phone:( 503 )292-5346 Fax: :( ) Tub/shower/shower pan 12.51
-- - Urinal 25002
F-mail: sewer-septic.r alphacnvironmental'net 25.02
- - Water closet
CONTRACTOR--
Water heater 37.52
Business name: Alpha Environmental Services Water piping/DW V 56.29
Address: 11080 SW Allen Blvd,Ste 100 Other: 25.02
City/State/ZIP: Beaverton,OR 97005 Subtotal
Minimum permit fee: $72.50
Phone:( 503 )292-5346 Fax:( )
Plan review (25%of permit fee)
CCB Lie.: 152125 Plumbing Tic.no.:PB1612 State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
/J Date:4/18/22 This permit application expires if a permit is not obtained within ISO days
Print name: � �8{��fa{`�i'( after
gy ace Tn.as n oonty ud as Industre.
(/// (�fJ "Fee methodology set by Tri•CounTy Building Industry Service Board.
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