Permit ill „�n�, SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00190
T IG A RD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/31/2007
i `t : a, , PARCEL: 2S112AB - 01200
SITE ADDRESS: 07325 SW BONITA RD ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: HORIZON RESTORATION
Project Description: .7 EDU increase for commercial building.
TENANT NAME: HORIZON RESTORATION
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 0.7
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
TENNANT INVESTORS
PO BOX 1658 Description Date Amount
PORTLAND, OR 97207
[SWUSA] Sewer Connection Fee 7/31/2007 $3,640.00
Refund - [SWUSA] Sewer Conne 7/31/2007 - $3,640.00
Phone: [SWUSA] Sewer Connection Fee 7/31/2007 $1,960.00
Total $1,960.00
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 copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
r
APW Issued by: 0 I -!� 7 Permittee Signature i�1 / •#%� /
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.
(, �o 9.; 388
_ . 1 5 ' 7 0. 7 -66 1 90 5cve2ao
Plumbing Permit Application w � � s '��� 7' o o cE' ,„ " t ir . vTwf � e" *'k-
City Of Tigard Date /B 1 Received /e permit No PL-/ 24
13125 SW Hall Blvd., Tigard, OR 97223 y z// v
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
' I'� Date/By: Other Permit No.: 6UP7.do7
. . ..
24- Hour Inspection Line: 503.639.4175 ' 'e! 'i�
Internet: www.ci.tigard.or.us .tt»iwr - -I I1�. Date Ready /By: Jurir 0 See Page 2 for
g Notified/Method: n 7 Supplemental Information
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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: - 7 3 /J S S L&) R., W .1-7,,_ Rte(
Catch basin or area drain 16.60
City /Slate /ZIP: � r'Gq a_ tr"'v7- O r , cl '7 2_2:3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: o Project name: 1-1,e, i i L G l� 12 r s l , �`1� F:rf Footing drain (no. linear fr.: ) 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.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
R Fit C L : r ,) aTo ,.:k e T 1
Se — T. Lr e,S Backwater valve 16.60
- for J - 6)2 , -Ter C /r;sr- ) 1 -Lf�✓ I -C(c'i i es (,JaSat.,- / 661 �, : Ce0
' Dishwasher 16.60
`2... - 5•'l4-) 1:� . Drinking fountain 16.60
❑ PROPERTY OWNER - I _ ❑ TENANT
Ejectors/sump 16.60
Name:
Expansion tank .1
Address: Fixture/sewer 16.60
City /State /ZIP: Floor drain/floor 661
Phone: ( ) Fax: ( ) Garbage disposal • 1
Hose bib
❑ APPLICANT `: ❑ CONTACT PERSON 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 • 16.60
/
Phone: ( ) 1 Fax:: ( ) • 1 ��
• 16.60
E -mail:
Urinal ..1
CONTRACTOR closet ••1 `p ,&AO
Business name: 01 C £.k4Lrti! C ( ., d i e e s „ r 1. L ( - 16,60 : E 0
Address: f` Other: • 1 `• ti� l 1_ a
:2- 11M'S iv 1ue 4 reen3 ek�1i,i 1 t i ��_ 1
City /State /ZIP: O 4 a , ■ � ;' Subtotal �
l ltSb 0,(ry ) ( -. 17) 2 { 1 1/6 . 20
Phone: 5 e > 3 ) 1139 _ a I 9 i y c Fax: (S 9 y 3 9 -1 e(ci cr Residential backflow minimum permit fee: $36.25
CCB Lic.: i j. G i Plumbing Lic. no.: . • • permit Ii'.►
' � it •
Authorized signature: j ►•
\ , t, r TOTAL PERMIT FEE a11 ,
Print name: '� ti .� V\ 0 0 ` ` �r Date: / go p 7 This permit application expires if a permit is not obtained within
1 c 180 days after it has been accepted as complete. X15 , 5D
*Fee methodology set by Tri- County Building Industry Service Board.
i:" Building \Permits\PLM- PermitApp.doc 06/05 440- 4616T(10 /02 /COM/WEB)
Accumulative Sewer Tally Parcel # ;;2S112AB -01200
Tenant Name: Horizon Restoration Inc., LLC This SWR# SW R2007- 00190
Site Address: 7325 SW Bonita Rd. This PLM# PLM2007-00337
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
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 Drn 6 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
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- Bar /Lavatory 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
,
- Commercial 3 0 0 0 0 0
- Service 3 0 1 3 2 6 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 1 6 1 6 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 9 5 20 3 11
Current Fixture Value 11 divided by 16 = 0.7 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 11 divided by 16 = 0.7 over (under) $ 1,960.00
Enter EDU Change Here : 0.7
Notes:
Authorized Name/Signature: Savanna Newell Revised 7 -31 -07 BB Date: 7/31/2007
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.
I:\ Building \Forms \SewerTallySheet.xls 02/02/07