Permit ' rn CITY OF TIGARD SEWER CONNECTION PERMIT
• COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00271
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2007
PARCEL: 2S 111 AB - 01700
SITE ADDRESS: 09230 SW ELROSE CT ZONING: R -4.5
SUBDIVISION: ELROSE TERRACE LOT: 013 JURISDICTION: TIG
PROJECT: ELROSE
Project Description: Sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
BEARD, JOHN D + LYNN C CO -TRS FEES
9230 SW ELROSE CT Description Date Amount
TIGARD, OR 97224
[SWUSA] Sewer Connection Fee 10/15/2007 $2,800.00
[SWINSP] Sewer Inspection Fee 10/15/2007 $35.00
Phone: 503- 639 -6882
Total $2,835.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
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 copies of these rules or direct questions to OUNC by calling 503.246.6699
or 1.800.332.2344.
•
Issued by: / � � V/ Permittee Signature: • / 41.
Call 503.639.4175 by'7:00 a.m. for an inspection that b iness 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.
Plumbing Permit Application- -v% ii Building Fixtures t 1 i' ., j .. a � ,� � �,�„ r.k „ r . , I� „, ,, ,,
�t . ro� ir , ,y, ,. FOR'KOFFICE U (ONL ]Y r� ,
l i ,� a ,
?��. ��'S�i "*�;m � � 4'�r , k t J1fL �.tDi >ti Vid Mrd � i�
� tl s +1'.�n �i'�,n� ;1r�A'�d °G i a i L"e o J L I sit : �� �,:, r . � �i. w � t'�Y :
CI of Tigard {� r• Received Permi
a 13125 SW Hall Blvd., Tigard, OR 972P1�" j 15 2007 Date/By: /1 ?3_6 pL zoo - 4 " ( a
Plan Review � �
III
Phone: 503,639.4171 Fax: 8 1.960 Date/By- Other Permit �p O
Inspection Line: 503.639.41X1 L 1 I i (JA. e
:TAG A R D; P Y Date Ready/By: ® See Page 2 for
Internet: www.tigard - or. TM� g Notified/Method: Supplemental Information
r�ti `� J
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 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
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq, ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: q' 230 5, GO , EjR OS E CT Catch basin or area drain 16.60
City /State /ZIP: Tl GR 6 2 D in tQ E--.0 ^-' cf , 7 - -2 `f Drywell, leach line, or trench dram 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector / 16.60
Sanitary sewer (no. linear ft.! DU) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
tv".Q C�UI - -1-b k _ Backwater valve . 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Toff N D + J, ytiN C, B x-79 RD Expansion tank 16.60
Address: C1 23 O 5 ,, tA) , E Lt2 OS E CT Fixture /sewer cap 16.60
City /State /ZIP: 7' j 6.46\ R 0 R t -) 4 7 .2.y Floor drain/floor sink/hub 16.60
Phone: (S'03 ) ,39 - 6 €3 2 - Fax: ( ) Garbage disposal 16.60
'0' APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
' CONTRACTOR' Water closet 16.60
Business name: pi EST- i D E tx)DeR Cr2Cwa O .1.b'tit_1 Tt is S Water heater 16.60
Address:
Othe `v At t l,t ' _Q
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 n)
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 V-. 5 v
Plan review (25% of permit fee)
CCB Lic.: //O( Plum n ic. no.: - State surcharge (8% of permit fee) S. 8((
Authorized signature / TOTAL PERMIT FEE '7 8',
Print name: 'G t e ,_, R). Date: it) -1 S AOo This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(10 /02 /COM/WHB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
• including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
•
• Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees*. ❑ Any new commercial building with water service.2" and
•
Quantity by (Fixture) Work Performed • greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
•
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Building\Permits\PLM- PermitApp.doc 12/27/06