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Permit MICITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00325 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/31/2007 PARCEL: 2S112AC SITE ADDRESS: 14865 SW 72ND AVE ZONING: I -L SUBDIVISION: FANNO CREEK ACRE TRACTS LOT: 047 JURISDICTION: TIG PROJECT: DOGGIE CENTRAL Project Description: .8 EDU increase. TENANT NAME: DOGGIE CENTRAL CWS NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS: 0.8 TYPE OF USE: CMS NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Owner: PARRISH /CHURCH FEES 16320 RHUS CT. Description Date Amount TIGARD, OR 97224 [SWUSA] Sewer Connection Fee 12/31/2007 $2,240.00 Phone: 503 - 692 -4742 Total $2,240.00 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: Permittee Signature: CaII 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. PlumbTE Permit Application BrIlil Fixtures ECE %V ED FOR OFFICE USE ONLY R eceived City of Tigard P ermit No.: • 13125 SW Hall Blvd., Tigard, OR 3 1 2001 Date/By. �� / 7 7 "' J7s 1 11 f7 Plan Review Q P hone: 503.639.4171 Fax: 503. 19 0 Other Permit No.� /�. ,123'055,75 Inspection L ine: 503.639.4175 G of r�GA�U D ate /B y: j I� p Date Ready /By:>"s! M See Page 2 for Internet: www.tigard - or.gov BUll.O NG01VISI)N Notified/Method: � '� ( p, Supplemental Information TYPE OF WORK IV17� FEE* SCHEDULE y New construction El Demolition For spedal information use checklist Description 1 Qty. Ea. 1 Total ddition/alteration/replacement ❑Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CON ' UCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling F 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 / (1 gI4( JOB SITE INFORMATION AND LOCATION Site utilities o � Job site address: ., _ r-1(/ -22- w /het Catch basin or area drain 16.60 City /State /ZIP: 774 d)&-- ci 7Z z_--r Drywell, leach line, or trench drain 16.60 Suite/bldgiapt. no.: r Project name: f flt'_ c 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.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: tin i ig jLa:. r ----7 , i 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 . Backwater valve . 16.60 Clothes washer / 16.60 Dishwasher 16.60 Drinking fountain 16.60 PROPERTY O R I ❑TENANT ® `� 40e.a7 Ex tan 16.60 Name: ,K,t. Expansion tank 16.60 Address: 6 , 74'J Fixture /sewer cap 16.60 City /State /ZIP: 0 i ,,/ _ i 7 -2-1-4( Floor drain/floor sink/hub 16.60 Phone: ` u, ) 6 .Z - _[ 7 2__ Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 g APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Business name: Titt,e/16 C91, 0 Interceptor /grease trap 16.60 Contact name: gas (value: $ ) Page 2 Address: `a ,7 sE g,1.66,,_ V 7..ei [_ AL , Primer 16.60 City /State /ZIP: J , }4j/j" c. / a(-- 7c) f' Roof drain (commercial) 16.60 q G! x . Sink/basin/lavatory 7 16.60 Phone: ( ,!� /) � [J ' [ ��f � /��,,� � � I Fax : : �� " ) fJ ��Q 2- l 0 Ge/� 4e. Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: ArK ail& ce,t ./.., c _ Water heater / 16.60 Address: /90 Fr &dn.4. 4,-, Other: Subtotal City /State/ZIP: Q fZ q 70 r)� Q Minimum permit fee: $72.50 - Phone: (�1 ) 'L'r �10�- Fax: (m) r/ 2i /f .7 / Residential backflow minimum permit fee: $36.25 /1i CCB Lic.: / 3 -s. �' , Plumbing Lic. no.: "S 9 4 Plan review (25% of permit fee) Authorized signature: Z.tq State surcharge (8% of permit fee) TOTAL PERMIT FEE Print name: ` ' L� G Dater _V-D 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. 1:\ Building \Permits'PLMF- PermitApp.doc 12/27/06 440- 4616T(10/02/COM/WEB) 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 - 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 $I.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 Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and Fixture or Item 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. Fixture Work. Plan Review for Plumbing Installations Are you capping, dding 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 2.., 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 •