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HomeMy WebLinkAboutPermit (25) CITY OF TIGARD SEWER CONNECTION PERMIT s COMMUNITY DEVELOPMENT Permit#: SWR2022-00113 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/17/2022 Parcel: 2S102BCO2000 Jurisdiction: Tigard Site address: 10690 SW FONNER ST Project: COSENZA Subdivision: NORTH TIGARDVILLE ADDITION Lot: 24 Project Description: Sewer connection for existing dwelling. Contractor: Owner: COSENZA, JENNIFER LYNN 10690 SW FONNER ST TIGARD, OR 97223 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 08/17/2022 $6,625.00 Type of Use: SF Sewer Inspection-Residential 08/17/2022 $35.00 Class of Work: ALT Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $6,660.00 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 Issued By: Permittee Signature: G7 Call om— 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 epermit No.: ■ 13125 SW Hall Blvd.,Tigard,OR 97223 AUG +� 77 plan R AR Phone: 503.718.2439 Fax: 503.598.1960 ULo,L plan Review Da"'./By. Other Permit No.. d�. J l Y� Inspection Line: 503.639.4175 ,^ rr TiC Date Ready/By: Jurts" ®See Page 2 for Internet: www.tigard-or.gov v��Y U� netripNotiSed/Method: Supplemental Information ❑New construction ❑Demolition For special in ormadon use checklist Description I Qty. I Ea. Total Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection) mmlsmml _ SFR(1)bath 312.70 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ❑Accessory building ElMulti-family SFR(3)bath 500.32 Each additional bath/kitchen 25.02 ❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 Site utilities: Job site address: ' Q 6 Cl Q S w Catch basin or area drain 18.76 City/State/ZIP: al Drywell,leach line,or trench drain 18.76 2 (-rl ZZ 3 A �� Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: roject name: u f'i t4l p w Manufactured home utilities 50.03 Cross street/directions to job sit Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:U3 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.: Backflow preventer 31.27 OE s rte: Backwater valve 12.51 Clothes washer 25.02 h t�-l" 4-1 Gr- 6Li d 4-c" Dishwasher 25.02 Drinking fountain 25.02 Co S 24 < GK�j �( Ejectors/sump 25.02 Expansion tank 12.51 Name: Fixture/sewer cap 25.02 G Floor drain/floor sink/hub 25.02 Address: Q () r } Garbage disposal 25.02 City/State/ZIP: 1' C4 C-i Hose bib 25.02 Phone:(A2�A Q Fax:( ) Ice maker 12.51 n< " 11LtA , 3 tWOW yc: Interceptor/grease trap 25.02 Business name Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: ` „h Roof drain(commercial) 12.51 Address: 1 6 r Sink/basin/lavatory 25.02 City/State/ZIP: j ©V_ Solar units(potable water) 62.54 Phone:(150'3 2_ 0 . Fax::( ) Tub/shower/shower pan 12.51 E-mailr u t /!,at Urinal 25.02 C(�, Water closet 25.02 k " Water heater 37.52 Business name: on Water pipinol 56.29 Address: Other: 25.02 City/State/ZIP: is Subtotal Phone:( ) Fax:( ) Minimum permit fee: $72.50 sy CCB Lic.: Plumb Lic.no.: Plan review (25%ofpermit fee) State surcharge(12%of permit fee) '-70 Authorized sign ire: TOTAL PERMIT FEE Print name: Q S to j�Za'� Date: t �y This permit application expires if a permit is not obtained within t80 ays after it has been accepted as complete. Cbi "Fee methodology set by Tri-County Building Industry Servicp.Board. 1:\Building\Panuts\PLMU-PermitApp.doc 10/01/09 440-4616T(i0/02/COM/wEB) / l 77ql Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppss on S stems: Ada• � ... n u1 S Footing drain-1 s'100' 50.03 0 to 2,000 $121.90 Footing drain-each additional 100' 37.52 2,601 to 3,600 $169.69 3,601 to 7,200 $233.20 Sewer-1 st 100' 62.54 7,201 and greater $327.54 Sewer-each additional 100' 37.52 Water Service-1st 100' 62.54 Medical Gas S stems• Water Service-each additional 100' 37.52 Storm&Rain Drain-1st 100' 62.54 '��� � i• $1.00 to$5,000.00 Minimum fee$72.50 Stone&Rain Drain-each additional 100' 37.52 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1.52 for „ .;, each additional$100.00 or fraction thereof,to r - a � a ' and including$10,000.00. Inspection of existing plumbing or for $10,001.00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for which no fee is specifically indicated 90.00/1117 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 $379.50 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 $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for (minimum charge-1/2 hour) each additional$100.00 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 1 Qui►uti b FtYiurt'[` oe `I Plan review is required for any of the following. Fixture Type for `aspta�/ Please check all that apply. WorkPerforaned• Gapped Added Relocate ❑ Any new commercial building with water service 2"and Baptistry/Font greater,except systems designed and stamped by licensed Bath: -Tub/Shower engineer. -Jacuzzi/Whirlpool Car Wash: -Each Stall ❑ New exterior plumbing site utilities for any complex structure as defined in OAR918-780-0040. -Drive Thru Cuspidor/Water idor/Water As irator El Medical gas and vacuum systems for health care facilities. Dishwasher Commercial ❑ Any multipurpose fire sprinkler system. ElAny complex structure as defined in OAR918-780-0040. Domestic Drinking Fountain Eye Wash Submit 2 sets of plans with any of the above. Floor Drain/sink: 2" $µ WANK x .. 3" a a, 11t '1 4" ❑ Isometric or riser 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./Refri .Drains Comments regarding fixture work: Oil Separator(Gas Station Rec.Vehicle Dump Station Shower: -Gang -Stall Sink: -Lav/Bar non-food related -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 plumbing permit can be issued. Urinal Other Fixtures: I:\Building\Permits\PLMF_PermitApp.doc 08/04/2011 2 Property Owner Statement Regarding Construction ResponsibilitieRECEIVE Oregon Law requires residential construction permit applicants who are not licensed wi>Mt1 7 2022 Construction Contractors Board to sign the following statement before a building permit can �IGARU issued. (ORS 701.325 (2)) CITY 81111 DINn 10l This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: 1 own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date E] I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or 0 I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. j'w*tjtV- costou"\- Print Name of Permit Applicant 71'7 7 Sign ure f Permit A lic t Date Permit#: Address: Q; rr a : Issued by: Date: This Copy for Permit Offices