Permit C ITY F TIGARD SEWER CONNECTION PERMIT
i DEVELOPMENT SERVICES PERMIT #: SWR2005 -00360
� �i DATE ISSUED: 1/19/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
/0 PARCEL: 2S110AA -CC001
8/
SITE ADDRESS: SW CANTERBURY LN BLDG 6 ZONING: R - I2
SUBDIVISION: CANTERBURY CREST LOT: 001 JURISDICTION: TIG
Project Description: Building 6: sewer connection for 6 unit condominium.
TENANT NAME: CANTERBURY CREST
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 6.0
TYPE OF USE: MF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
CANTERBURY PLACE LLC
109 EAST 13TH STREET Description Date Amount
VANCOUVER, WA 98660
[SWUSA] Sewer Connection Fee 1/19/2006 $15,600.00
[SWINSP] Sewer Inspection Fee 1/19/2006 $45.00
Phone: 360 - 695 -7700
Total $15,645.00
Contractor:
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow 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 cosies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued , y: ! / , ,, - Permittee Signature:
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.
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City of Tigard t ` p 's' Ei Receives _.
g Date/By. IB i 6.) 3--__ Permit No: W„\ale' J �J r J
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 20 (1 /��rad
4r 1 4 t Degy: j/ i / rJ OS Other Permit No.: S-{,0
24- Hour Inspection Line: 503.639.4175 C IJ , • _' 1 ' Date °" la See Page 2 tor
Internet: www.ci.tigard.or.us vITY Notified/Method: ''� ( Supplemental Information
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® New construction ❑ Demolition Forspedal information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ® Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other. Fire sprinkler ( sq. ft.) Page 2
i y 9 JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 4_SW Canterbury Lane Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: BLDG (Q I Project name: Canterbury Crest Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Canternury Lane off HWY 99 S of SW McDonald Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 100) ` Page 2 3S , 00
Storm sewer (no. linear ft.: 200) 1 Page 2 10 I , go
Subdivision: Canterbury Place I Lot no.: Water service (no. linear ft.: 1L)_0) 1 Page 2 C5 , 00
Fixture or item
Tax map /parcel no.: WCTM 2S110AA, 01500,01400
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer O Page 2 c/ Q • 4 60
New Construction of Condominium Units Backwater valve 16.60
Clothes washer (p 16.60 gA , ( 1 0
Dishwasher (p 16.60 qcl , 00
® PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Canterbury Place LLC
Expansion tank (• 16.60 Gil ' 60
Address: 109 East 13 Street Fixture/sewer cap 16.60
City/State/ZIP: Vancouver, WA 98660 Floor drain/floor sink/hub 16.60
Phone: (503)221 -1920 Fax: (360)693-4442 Garbage disposal to 16.60 C' Q , ( 0
® APPLICANT ® CONTACT PERSON Hose bib �p 16.60 q • G 0
Ice maker 16 61
Business name: Canterbury Place LLC
Interceptor /grease trap 16.60
Contact name: Dave Gutschmidt Medical gas (value: $ ) Page 2
Address: 11624 SE 5 Street Primer 16.60
City/State/ZIP: Bellevue, WA 98005 Roof drain (commercial) 16.60
Phone: (360) 695 -7700 Fax: : (360) 693 -4442 Sink/basin/lavatory - 16.60 3 32• 00
Tub /shower /shower pan / 0 16.60 / (, , 00
E -mail: Urinal 16.60
CONTRACTOR Water closet i 0 16.60 1( ( , 00
Business name: Cromwell Plumbing Inc Water heater (p 16.60 CMC(, ( 0
Address: 30855 S Kauffman Road Other. �/
City/State/ZIP: Canby, OR 97013 Subtotal `5'/7
Minimum permit fee: $72.50 1
Phone: (503) 266-4790 Fax: (503) 266-4792 Residential backflow minimum permit fee: $36.25 S � I
CCB Lic.: 44712 Plumbing Lic. no.: 34-167 PB 5 070 /3' Plan review < of permit fee) 1 J 2. .
Authorized signature: State surcharge (8% of permit fee) / 1/ . 5
TOTAL PERMIT FEE / g 3`d . q 7
Print name: Greg Cromwell Date: This permit application expires if a permit is not obtained within
180 days after it has been accented as comolete.