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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2006 -0931 DATE ISSUED: 6/28/2006 / eL 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103CB -00200 SITE ADDRESS: 13065 SW 121ST AVE ZONING: R -4.5 SUBDIVISION: WILLAMETTE LOT: 002 JURISDICTION: TIG Project Description: Sewer connection. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 50 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES LEAR, JOE JR + JOANN 13065 SW 121ST Description Date Amount TIGARD, OR 97223 [TAX] 8% State Surcha 6/28/2006 $5.80 [PLUMB] Permit Fee 6/28/2006 $72.50 Phone : Total $78.30 Contractor: TED MCBEE EXCAVATING INC 11428 NE SCHUYLER PORTLAND, OR 97220 REQUIRED ITEMS AND REPORTS Contact # : PRI 939 -5246 Reg #: LIC 110314 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -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: ---22-Z f 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. Building Fixtures b Plumbing Permit Application FOI( Ol I I( I: I SI.. ()Nil City of Tigard Received _ Date/By: - u ` � q Permit No. . (/ , /f d L IN i l 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review l • Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit No.: TIC] .A 1: l� Inspection Line: 503.639.4175 Date Ready/13y: Juris ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: -t- I ( Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ N construction ❑Demolition For special information use checklist Description I Qty. I Ea. .1 Total Addition /alteration/replacement 0 Other: New 1 dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 249.20 ri I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 El Accessory building El 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: ( '3(0 5- 50 . 121 ? .. fe , Catch basin or area drain 16.60 City / State/ZIP: Ty r t--ci Drywell, leach line, or trench drain 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.j ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: 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 5e wE24r s ervl c e. C i 144 p t d b1 " Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: \TQLpar Expansion tank 16.60 Address: / :3 9 c s ,,,),, ( 2 ( -51t Ave , Fixture /sewer cap 16.60 City/State/ZIP: a Floor drain/floor sink/hub 16.60 Phone: ( ) , `� Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: N i at, a,° S 3 . !-'k t3ea_ Interceptor /grease trap 16.60 Contact name: O Cet P( �,�. t �S 6 I Medical gas (value: $ ) Page 2 Address: (( (O 3 ` riiirves Primer 16.60 City /State /ZIP: C ( it uC Q 72_2 -Z- Roof drain (commercial) 16.60 �) Sink/basin/lavatory 16.60 Phone: gag 23 ?.2_707 Fax: : (5j 9 ) 9_s iO7V Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CO RACTOR Water closet 16.60 Business name: Water heater 16.60 Address: Other: City /State/ZIP: Subtotal Minimum permit fee: $72.50 Phone: ( ) - Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: t . / ✓ i Plumbing Lic. no.: Plan review (25 % of permit fee) State surcharge (8% of permit fee) Authorized signature: //JJ TOTAL PERMIT FEE 3 3 Print name: /i1�il, � Date: - ©� This permit application expires if a permit is not obtained within ,AA/���///��JJyy '�6b�xii 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 04/06/06 440-4616T(I0/02/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 - 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 Subtotal: each 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 Complex Structures Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system that meets any of the following criteria accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor /Water Aspirator are being installed for the food service area . Dishwasher - Commercial ❑ Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" Submit 2 sets of plans with any of the above. -3" -4" Car Wash Drain Isontetric Riser. Diagram Garbage - Domestic ❑ Isometric or riser diagralp is required for new buildings Disposal - Commercial three (3) or more stories in height. - Industrial Ice Mach./Refrig. Drains Oil Separator (Gas Station) Comments regarding fixture work: Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley -Commercial - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture work under this permit results in an Water Extractor Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and Urinal fees assessed for the sewer increase must be paid before the Other Fixtures: plumbing permit can be issued. i:\ Building\Permits\PLM- PermitApp.doc 07/06/05 • Return Recorded Document to: �- City Hall Records Section �� / c w / 1 Z' City of Tigard 13125 SW Hall Blvd��"�'- Tigard, OR 97223 yy .". 1 2006 Sanitary Sewer Connection Fee Installment Payment Application and Disclosure Statement CITY OF i IIJf' - vv..r#%% -. Recitals • We, Joe and Joann Lear, Jr., are the owners of the property identified by Washington County as Tax Map and Lot # 2S103CB00200. The City of Tigard (City) has determined that the Owners must pay $8,713.30 sewer connection fees. The Owners have requested to pay such fees in installments. Agreements We hereby make application to the City and hereby agree to pay the sewer connection fee with interest at a rate equal to the U.S. Government Bond Ask Rate for the expected maturity date as of the 1 of the month in which the application is signed, plus 2 %. We agree to pay the balance due of $8,713.30 plus interest over a period of five years. The first payment will be due on the first day of the first month after the signing of the applications and each subsequent payment will be due on the l day of each following month. A schedule of payment due dates and amounts is attached to and made part of this agreement. Payments that are more than ten days late shall be subject to a $5.00 late charge. The entire unpaid balance will become due and payable, if any payment is not received within 30 days of its due date. In that event, the unpaid balance, including interest, will be collected, under the procedures for delinquent assessments under ORS 223.650. If the City proceeds to collect the unpaid balance under ORS 223.650, the City shall be entitled to an award of reasonable attorney fees and collection costs, even if no suit or action is filed. In the event a suit or action is filed, the amount of the reasonable attorney fees shall be fixed by the court, or courts in which the suit or action, including any appeal is tried, heard, or decided. The persons signing below certify that they have read and understood this document and voluntarily sign it, understanding that the provisions of this document are binding contractual agreements, with the consideration being the City's financing of the charges. This document constitutes the entire .greement between the parties as to payment of the sewer connection fee. Signature of Property Owner(s) ignature of Property iwn-r(s) STATE OF OREGON, County of Washington • SUBSCRIBED AND SWORN TO BEFORE me this � / — day of , 2006. o (_,03\5270 Notary P blic for Oregon OFFICIAL SEAL / v� CATHERINE D WHEATLEY My Commission expires / �( r \ ;: . NOTARY PUBLIC-OREGON COMMISSION NO. 371142 MV COMMISSION EXPIRES AUG. 04, 2007 , Jeremiah , Inc. ',)gUAL'LL(111 e1 � ij 810 E Main Molalla, OR 97038 DATE * -�_ (503) J " Dave's cell: (503) 209 -7641 NUMBS .. Newberg (503) 538-8808 �onQu Sllverton (503) 873-7622 1- 866 - 939 -7600 CCB# 158543 DEQ# 38346 Complete System Installation / 130g5 s w /2/5 / l 6 of TERMS: Net 10 Days. A service charge of 11/2 (18% per annum), $2.00 minimum will be applied to past due accounts. PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $ DATE CHARGES AND CREDITS BALANCE BALANCE FORWARD 0 rt ? r4 . , K D 1 �, D �° 744GLfQ 1pu PAY LAST AMOUNT II�THIS COLUMN