Permit CITY OF TIGARD SEWER CONNECTION PERMIT
I - COMMUNITY DEVELOPMENT Permit#: SWR2022-00055
Date Issued: 5/9/2022
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AC01100
Jurisdiction: Tigard
Site address: 11300 SW BULL MOUNTAIN RD
Project: Nectar Subdivision: None Lot: None
Project Description: .13 EDU increase.
Contractor: Owner: BULL MTN LLC
10685 SW CLAY ST
SHERWOOD, OR 97140
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/07/2022 $791.05
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $791.05
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
Issued By: Edgardo-M 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
Building Fixtures RECEIVE
City of Tigard Received } //��
f y g Date'B ' 4 J�1- Permit No 1
• 131-5 SW Ball IIlvd.,Tigard,OR 97223 t9 qtg y �K 1 t� t�il
iliNi APR. LOLI. Plan Review n �
Phone: 503.718.2439 Fax 503.598.1960 Other Pcnnn So �t/ (,�
Date/By:
Inspection Line; 503.G39.4175 CITY OF TIGARD y 1 ® ties Page 2 for
AM
1 1 G A R p Due Rcad tBy, �,.�j� ,��y�_
httemeC vcww.tit itd-or.guv Voritled Method 5 /" /�/tP I Supplemental Information
TYPE OF WORKBUILDING DIVISION At .r.e,IL4.I T ,,4) FEE* SCHEDULE
0 New constntrtion 0 Demolition For special information use checklist.
Description c1c3/. Ea.----1 Total
X'kddition alteration replacement - 0 Othei. New I-2-family dwellings I includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I 1 bath 312.70
❑ I-and 2-family dwelling XCommercialrindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family Each additional batlukitchen 25.02
❑Master builder 0 Other Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I 13U d j,/Vi ,pl-;L,r^\ c eq Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1 t q _ -a t o C1- 2-Z,�
,� ------------- Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name_ 1�j ea--0•,v, 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: Lot no: Fixture or item:
Tax map/parcel no.: al-510 a%1 00 Backilow presenter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
v p 2.-' .) 4- ZIl Qv$. A 1 Clothessha washere 25.02
�-' L Dishwasher 25.02
b L 6...so..-4.-- - A- 1,.-\(Q„i..Qlk4d4,' 6,4 CtAetr CCr+- Drinking fountain 25.02
(i?- .i)',t Y\..c7 GAY v�j-{ , we -" C +SPeY1 Seer- Ejectors/sump 25.02
0 PROPERTY OWNER ` 0 TENANT Expansion tank 12.51
i Fixture/sewer cap 25.02
4 i
Name:
Floor drain floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:t i lee maker t 12.51 1 2.•S1
APPLICANT 0 (()S1 A(7 1'i:Itsoti Interceptor/grease trap 25.02
Business name: tc. - Ps .bt_ Lk-_ {__ Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
O.Nn Root drain(commercial) 12.51
Address: `v-.lt-, sD V_ i•ie,,,eN, 4 Sink/basinliavatory' 3 25.02 '.s.0(p
City/State/71P: ,C.S 4 `,,,t,v,.v1 t 2q--i--01,0 Solar units(potable water) 62.54
Phone:( 3 ) S-3 C-'-(c- ( Fax::( ) Tub'showcr/shower pan 12.51
E-mail: i C"v✓" p 1 L.I.n..�.l r+.c fft{2.e t3 Yr-CIZ Q .t;.-.(N'--,
Urinal 02
CONTRACTOR Water closet 0 25.02 rS.C, .09
Water heater 37.52
Business name: -E y 1 \-.,`t_k b te,, L,,.L(_ Water i in DW V 56.29
PP & _ _
Address: tiLk k.. ' -j-e i\c Other: 25.02
City/State.Z.IP: Wer...�-W:-„r.v-Cj Gt-9-b 1„g' Subtotal 131-.(n
Phone:(S63) 5- c� `...kk,S-1 Fax:( ) Minimum permit fee: 572.50
CCB Lie.: 2 0%4 Lk� $' Plumbing Lie.no.. )SS s Plan review {25G„of permittee) f
State surcharge(12 of perm
it fee) ((o.S(
Authorized signature:
C•-- I t>I AL PERMIT FEE
(0_,,,, This permit application expires if a permit is not obtained nithin 180 classPaint name: S y Date:yl 8I2 after it has been accepted as complete.
i *fcc methodology set by Tri-Counry Building Industry Service Board.
1'/i lung-Permus PLMti-Permn•'pp.Joc to 01N4 440-46161(10/024.081iWL8)
eo, o•i3 i50eA - �,
•
Plumbing Permit Application - City of Tigard
Page 2- Supplemental information
Fee Schedule: Residential Fire Suppression Systems:
1 Site Utilities Qty. Fee(ea) Total Square Footage:_ 1 Permit Fee:
ooting drain-1 I(RI' 50.03 Ow2.0O1) S121.91)
Footing drain-each additional 100' 37.52 2.001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer- I st 100' 62.54 7.201 and greater $327.54
Sewer-each additional 100' 37.52
Water Service-1st 100' 62.54 Medical Gas Systems:
Water Service-each additional 100' 37.52 Valuation: Permit Fee:
Storm&Rain Drain- 1st 100' 62.54 S 1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 11)0 37.52 $5,001.00 to$10,000.(10 $72.50 for the first$5.000.00 and$1.52 for
Other Inspections or Fees Qty. Fee(ea) Total each additional$100.00 or fraction thereof to
and including S 10,000.00.
Inspection of existing plumbing or for $10,001.00 to$25A00,00 $148.50 for the first$10,000.00 and$1.54 for
which no fee is specifically indicated 91t.0{1.1tr each additional$100.00 or fraction thereof,to
(minimum charge—1/2 hour) and including$25.000.00.
Inspections outside of normal business 90.00/hr $25.001.00 to$50,000.00 S379.50 for the first$25,000.00 and$1.45 for
hours(minimum charge—2 hours) _ each additional$100.00 or fraction thereof,to
Reinspection Fees 90.00/hr and including$50,000.00.
Additional plan review for revisions 90.00/hr S50,0(11.00 and up $742.00 for the first S50,000.00 and$1.20 for
(minimum charge—1/2 hour) __ each additional S100.00 or fraction thereof,
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. Plan Review for Wil.._ ` g,I i':tions
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace! Please check all that apply.
Work Performed: Capped Added Relocate
❑ Any new commercial building with ater service 2"and
Baptiste.Font greater,except syste s desi d a stamped by licensed
Bath: -Tub,Shower"
engineer.
-Jacuzzi/Whirlpool
Car Wash: Each Stall ❑ New exterior plumbin ite utilities for any complex structure
Drive tall as defined inc 18- 0-0040.
Cuspidor/Water Aspirator ❑ Medical gas a' vacuum systems for health care facilities.
Dishwasher: Commercial ❑ Any multipurpo a fire sprinkler system.
Domestic ❑ Any complex structure as defined in OAR918-780-0040.
Drinking Fountain
Eve Wash Submit 2 sets of plans with any of the above.
Floor Drain/sink: -2"
-3" Isometric or Riser Diagram
"LI Isometric or rise! diagram is required for new buildings
-Car Wash Drain
that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related
Ice Mach.iRcirig.Drains Comments regarding fixture work:
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related i �.-
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes
fees assessed for the sewer increase must be paid before the
Water Extractor
Water Closet-Toilet Z plumbing permit can be issued.
Urinal
Other Fixtures:
I l3uilding\Permits\PLMF_PermitApp.doc 08/04i2011 1
Accumulative Sewer Tally
•
a Tenant Name: NECTAR Accumulative
# 2022-00055
Site Address: 11300 SW BU1.I,MOUNTAIN RD PLM# 2022-00170
TIGARD
Parcel#: 2S110AC01100
Fixture Value Previous Prc\iouo Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 _ 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 0 0 0
• -4 inch 6 0 0 0 0 0
-Car Wash 6 1 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 1 2 1 2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU= $6,085.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 2 divided by 16= 0.125 over (under) $ 791.05
Enter EDU Change Here 0.130
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: BRANDEN TAGGARI'X2449 Date: 5/6/2022
Building Division
e Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet_6085_070121.xlsx