Permit 4" CITY OF TIGARD SEWER CONNECTION PERMIT
. r
2 COMMUNITY DEVELOPMENT Permit #: SWR2010 00035
T +,f Date Issued: 03/19/2010
T TGARD! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 102 BA00302
Jurisdiction: Tigard
Site address: 9900 SW TIGARD ST
Subdivision: Lot: 0
Project: High Impact Tech
Project Description: .2 EDU increase
FEES
Owner:
TIGARD INDUSTRIAL LLC Description Date Amount
5805 JEAN RD Sewer Connection Fee 03/19/2010 $720.00
LAKE OSWEGO, OR 97035
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .2
Total $720.00
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 -0100. You may obtain a copy of the rules
Or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i
D
Issued By: A / ` Permittee Signature: ,l /'
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
I
03/10/2010 11:26 5037719454 ,., CROWN PLUMBING PAGE 02/ 03
/i-i
Pillipp_it A licatia ' ' --
Building :Fixtures MAR 10 2 013 •
City of Tigard f iy k ,..: ..,-, , PC71
,
I ■ " 11 if NG.: 1 /0- 70
_ 11 13125 SW Flail 731vd., iigro 0 R 9.7,2U • . - f - I CIL/
- —
DateillIv;
- ill • '. Phone: 505.639,4171 Fax: 503.50.1q66:': !):‘;:inin ' it e' ,., i I Pe I No A70:)/6 - 35
IN
:._.. . , ,. , m,_,,,,,_,
in,pectioi, Line: 503.639 4 I 7
nnte ftendy/ByVini ' - '' J" f0 are Nip 2 for
. 1 . IC; to.tr) .
i,
int 7..MC1,' WWII/. ti gaITI•Orlinv
Nznified/Vel,lincl: _.,,, ., _ j .........! $u • lamer t111 Info•nisainn
' ' - '!
thirt OF *OM .
For , specra/i/WarnfiatiOn Ine CherkfiNt.
,—, '—''''-----"---"'"' Descri . don ] _Qv. f_ ED, 1 1
n N
,
ov construcuon I '....i Demolition
- __
,-., New I- 2-family (11.1.'0111cup (includes 100 ft, for each utility conneetior
'lW Addition/a here don/replacement j 1 - 1 Oth --
er: . SFR Wraith _
249.20 --
CATEVORY OE CONSTRUCTION ' i i SFR (21 bath 35(1.00
srR (3) Imo,
399,00
ID I. rind 2-family dwelling V Corrint ercia,l/industrial _ _ -
i mit iti.ramily Erich addi_ral bath/kitchen 45.00
0 A eCeasory bei I cl i n p
.._. ..-_______ Fire ;Aprinkler (. , sq. ft.) Page 2
Master builder 1_:1 ()tiler: __________
Site uti1Itiem
- ., . i - -- __
--
i1Oft ME INFORMATTON ,Nrcn 1:01;T:ATIPN Calch hnsin or nten drain T 6.60
job sits Fiddrew 9 7 0 s kJ , ,..,., r _ DI-ywe,11,1cActi line, or lunch drain i 6,60
....__
Footing drain (no. linear fl.: ,..) Page 2
City/State/Z1P •or eqz_ 5. 7 .__
Suitc/b idglapt no.: 1 Project name: 14( 6t.t 11-1)0Aidr m.inIrracilired home utilities
_ — 110.00
-._
' „Manholes 16 60
Cross strecticl i rectiona in job siic: .— --- — - ..„._
_. Rain drain connector '16.60
—
Sanitary sewer (no, linear R.: ___) Page 2
„, _
— Storm sevvcr (no. linear 11'.. __ ) Page 2
--. .---
Water service (no. linear ft : __.) _ Page 2
Fixture nr iival
subdivision: F7,10.: ,... --
-----_,- ----___ At,F,,,-pith, vidve
10
6.6
Tax ma,p/parcel no.: 605 . _. _
1-1Frelcilow pieventer Page 2
OINCRPTION OV Iviciltk , e .
ricwItriV3I'VC 16.60
- ----
........-
PI ) il t 't. .....? ..r : — k. clolbc8 washer
16.60
a4 tp 4i,Jer,4i,...1 __..____._._____._ Dishwasher
---------,-- 1660
--
Drinking fountain _ 16,60
________
Heti ors/sump 16.60
—7---- 7V(6 7 1 7 1 - 11i1Crif OWNER -- n iftINANIf
7— --16,60
Name:
_ — _-__ Fixture/sewer cap 16.60
Addres 1 -
__
s:
Floor drain/fl(or sink/h 1
uh 6.60
. — .
, C , ity/Statc/ZiPi ... . .... Garbage disposal 16.60
----..---_—_,---_—.._-, --..
' : ' V.r . ) Iiov HI, .,.. i 6,60
Phone' ( )
_.„„__,
7''.:74411TIE I" nialal ------.-- I 0.60
, • ,, '" ,- 1 ; ;;;:4,b;;; I :,,„,, % ' -..- idR - li:...$ '' ':'; , "iLL,;A:,' ' '•-• ' ." ' ...----_-_-....---_--
- ' liTierecpiorigrcase irnp I 6.60
Busincss name: Christian Plumbing Inc. DBA Crown Plumbing ..._ —_______
I --- - — — - IN/iodic:0i gas (value; ) Page 2
Contact name: Dennis Undeiwood ._
Address: 5429 SE Francit.q Street -
Roof' dra in (commerciall 16.60 '-
--_.
City/Stftte/ZIP: POI OR 97206
nk/basin/l
Siava iory _ J 16.60 IC.. tty
. .
I Phone; ( 503 ) _771 - 9449 1 F3X. : i 503 ) 771 — 7 il ivoosverillinwer pail 16.60
_ _ . ----------- --
.._
F.-mail:
_— I lirina I I O.G0
— --_______ .
... .". ..;'''.': Wa)(
e' u fosct 16.60
izuo 0 ' Y •'"i,..:ig::;'-•' J' , • •• • : ...:. — ..,..... _ _ —
i3usine tlVirric: Christian Plurnbing Inc. DBA Crown Plumbing wile — ,- heater
—
,,,-., -----_,— I 6 60
--.,-._
Other:
..
A.i.tdrcss; 5429 SE Francis Street _.._ ------ -
- -- ---
Subtotal
City/State/ZIP Portland, OR 97206
r. --......__,...._ -- Minimum r. 't f i 37 in
. p-rrni ee. , -,, „ ... .s
Phone: ( sn 771-4
t 9z19 Fax. ( 5035 771-9454 ., _ ReencIentiai Nieicriow min11111.1111 perirnit Fcc: fs.6,25 •
__.
E-mail: Plumbing tit ' 34-70PB - — Plan review (25% of permit (e)
- .— ______ —
Slaie 5111 ( 1 2% of pentiit fee) S. 70
CCB lic.: 42671 City or i no. '10.: ro 1431 i
. _______
— , ,..„ —
TOTAL PERMIT TTE 1
A uthorTa,7,cd • r. _......_ Tin!' permtt application expire.s If A perinii is nor obtifne41 with
i in
gnialivc:
um days after it bas been accepted AN compfrtc.
-...... --,. ., __ __—__
JYee methodology 9c1 )y TI.1..Colimy Rut !cling InchNlry 5;ervicc R on cci
Prinl ileunc: Dennis Underwood
....
I 2 7ISfi :14t1-.16 I ,, T(IC,111)(C ()A 71)
ka-i =80/ '
03/10/2010 11:26 5037719454 CROWN PLUMBING PAGE 03/03
,Elealnxb>il;jinAnacao - City of Tigard
•
Page 2 - Supplemental Information
Schedule:
Fee Sche
F e Scbe tlielg .. Residential Fire Su resst01e S stems: •
Footing d 71ntR1 S
r ain • 1" 100' 50.Oa quay 'apf$' i�: a cni fie: .
Footing drain -.cads additional 100' 0 2t0i70 _ 5121 g0
Sewer- 1st100" � 2 61 io3600 $169,69 W
Sewer - t sell adeitianai 100' ,601 to 7,200 2 IIIIIMN1 7 201 and greater --f 8327.54
Water Service - • 1st 100'
Water Service :cash additional 1.00' Gas v :terns:
37.5
Storm & Ran, ()Mill - Ist 100' ..
1527,74 i tal,ual'1f 111`: . ' :, , t'enni1�'� ee:
Storttt & Rain Drain - cm,* achlitional 100' 51,00 to 55 00 0. tt Minimum fec ; 2.50
3 7.52 55,001,00 to 510,000.00
0 th r Ina ecti01�g 8T Fees Qtr. Fee (ea} Total 572.50 for the first: 5.000.00 And l 1,52 for
Inspection of existing plumbing or for cinch additional 610000 or fraction thereof, to
which= !FCC i; specific :dry indicated and inctud the t • 510 0 55 b,O
00,00 and 51,54 for
90.00/hr
620,001.00 to $25,. fitvt 81 0,0
minimum charge _ 5/2 hoar
000 each r+00 314$.50 for the
or fraction thereof, to
lncpinspections ournidr, of normal business
hobt mini urn charge - 2 hours 90.00,111r 525.001.00 to $50,000.00 5379 SOuor The first 525, and 51.4.5 for
Rci>>npr,Gtion Fees 90 each additional $ of Ruction th d coto
plan review ;ti
J_� Arldtr tai pt w far revisions and inclu in. $.50,000.00,
d mttm p la, � °0 .r 350,001.00 and up ^ ' first $ and 52.20 for
rge I /2 how 00/h 5742,00 for the — _.
Snbmtai: each additional it n 00 or fraction thereof
Co me is e o
Are you Popping, adding or replacing fixtures? If "yes",
fixture. Failtire to _Plan t qu i r cd or PltC Ifbil� installations'. 1installations'. pleusc indicate work performed by
acc urat e re o>rtJCtitres could ~ trlan review is re quired'For an gfthc following.
result in increased sewer Fees*. PIGdoC Cheek all t
Fiktare T e• Q�antl� h xh that apply. yP • 1 WorR Any new commercial building with water SAl V1Ce 7" and
nea„rl ��1, , greaten except systems designed and S1;impt d by licensed
Da•tist /F .Tit
engineer.
Rath Tub /9hocvcr
Jacvzzi/y4hh1•oa!
El N exterior plumbing site utilities for any complex structure
Car Wash � as defined in OA 918 - 7$0 - 004, NEM
Ea: Stan d Medical gas end vacuum 55rstetm for 11081111 care facilities,
Ct�idoLWetcr /asp rotas�t ❑ Any multila Fro sprinkler system.
-
1]i�1,wn9her Commercial
C Any complex structure as defined in OAR918 -780 -0040.
210=, 5111brtlit ,2 sots of
E Drinking/cumin m Mans with any of the above.
E r- w ash - -, — -
MIMI
Floor Drain/aink - as ��4U �°
Isometric or riser diagram is required for new buildings
4., men that meet the uaTification5 above.
Car wash train
Garbage - Domestic . —
DispoCal -Commercial � �
-indua 'al
IceMsch.lRc{ri:. Drains Comments regarding xtutre work:
Oil c•a ntar Gas • to ton
,oc. Vehicle amQ _a _at on — -- --
1:ce. r gang �-
- Stu, -- --
Sink Bar2avac, ?ry r�
Bradley
Comfncrcirol M1111/1..11111...11.1.1 "'�"—
-Service * Note: Tf tl><c fixture work under this permit results in an
Washer - Clo nal Filter Increase of sewer TDC1s, w sewer permit will be is9aod and wtLther - Clatltcs - "`
fees assessed for the Stever increase most be
Watc tcr - tOr paid berate the
W d.- Closet . ^F. c t � Plumbing permit On 1)e issued_
Uri n1 _1.111.11
Other Fima.,res:
I:1Bt ti idi ng \P etmits\PLIWL: -Perm itApp.dOr
03/10/2010 11:26 5037719454 CROWN PLUMBING PAGE 01/03
. CROWN PLUMBING
5429 SE Francis Street
Portland, OR 97206
CCB # 42671
Phone (503) 771 - 9449
Fax (503) 771 -9454
FAX TRANSMITTAL FORM
To: City of Tigard From: Dennis Underwood
Name: Building dept Date Sent: Wednesday, March 10, 2010
CC:
Phone: Number of Pages: 3 including cover
sheet
Fax: (503) 598 -1960
Message:
Please call me with the total cost of permit and sewer charges.
Thanks,
Vei,'Uvtider'woo+d,
Accumulative Sewer Tally Parcel # 2S102BA00302
Tenant Name: High Impact Tech This SWR# ,2010 -00035
Site Address: 9900 SW Tigard St This PLM# 2010 - 00070
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptistry /Font 4 0 0 0 0 0
Bath - "1'ub /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
-3inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
- Car Wash Drn 6 • 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 32 0 0 0 0 0
- Industrial (over 5 1-IP) 42 • 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 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 1 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- Service 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
"I'O"1'AI.S 0 0 0 0 1 3 1 • 3
Current Fixture Value 3 divided by 16 = 0.2 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 3 divided by 16 = 0.2 over (under) S 720.00
Enter EDU Change Here 0.2
Notes:
Authorized Name /Signature: Debbie Adamski Date: 3/11/2010 '
Building Division
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.
1: \ Building \ Sewer 'l' ally \Sewer 1'allyShcet- 3600.xls 06 /25/08