Permit C ITY OF TI aARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Er PERMIT #: SWR2007 -00113
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/17/2007
PARCEL: 2S 102CC -01700
SITE ADDRESS: 10285 SW HILL VIEW ST ZONING: R - 3.5
SUBDIVISION: FRELEON HEIGHTS NO.2 LOT: 020 JURISDICTION: TIG
PROJECT: BRITTAIN
Project Description: Sewer connection for existing house. Reimbursement District #39 fee paid this date.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
PAUL & ANIT BRITTAIN FEES
10285 SW HILL VIEW ST Description Date Amount
TIGARD, OR 97223
[S WUSA] Sewer Connection Fee 5/17/2007 $2,700.00
[SWINSP] Sewer Inspection Fee 5/17/2007 $35.00
Phone: 619 - 934 - 0480 Total $2,735.00
Contractor:
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‘ CO REQUIRED ITEMS AND REPORTS
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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 co..-- • - -se rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Is ued by: Permittee Signature: a llo e , A �/
Call 503.639.4175 by 7:00 a.m. for an inspection t • . business day.
This permit card shall be kept in a conspicuous place on the'• • site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
' Plumbing Permit Application ..� E� 60 (4e e7D J /Eb1/7
-I .. ,. I. - -
1 FOR OFFICE USE ONLY
Received np
City of Tigard Date /By: 5 1 � t7 7 • Pennit No.: WI€�o?_ y / / 3
I . q 13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.639.4175
TtGA Ready /By: Read /B ®See Pa 2 for
Internet: www.tigard- or.gov Notified/Method: d: 1 Cok Supplemental Information
TYPE OF WORK . FEE* SCHEDULE
•
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. otal
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility c nection)
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
El Master builder Each additional ba, /kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page' 2
JOB SITE ,INFORMATION AND LOCATION. Site utilities
/
Job site address: I (7 a, g5 SCU llw/GCO S Catch basih or area dr :in 16.60
City /State /ZIP: //6—Al?-0/ O L. 9 92—Z3 Drywell, leach line, or . ench drain /16.60
Suite/bldg. /apt. no.: Project name: /3 A I-# i Footing drain (no. line. ft.: ) Page 2
Manufactured home utili 'es / 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
1 Water service, (no. linear ft.: ) ?age 2
Subdivision: I Lot no.: .
/ Tax map /parcel no.: Fixture or item
Absorption valve / 16.60
. 'l
DESCRIPTION OF WORK Backflow preventer Page 2
E�. N J &I E 7'/ O ti) Pe /L ,_(/ 7 Backwater valve / 16.60
Clothes washer / 16.60
Dishwasher / 16.60
❑ ,PROPERTY OWNER I ❑ TENANT Drinking fountain / 16.60
n ��jj
Ejectors /sump / 16.60
Name:
PAWL 1 A� � X727 n � //U Expansion tank / 16.60
Address: J q.g 1,0,46.0 5f � btu "an Fixture /sewer cap / 16.60
City /State /ZIP: / 5 A A) 101 t 6?-U 2 cig 9 ,,/s.--v Floor drain/floor sink/hub' 16.60
Phone: ( 61?) 7 3 ei —0v g0 Fax: ( )
Garbage disposal / 16.60
❑ APPLICANT Hose bib 16.60
❑�CONTACT��PERSON
' 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 (comt ercial) 16.60
Phone: Sink/basin/lavato'ry \ 16.60
( ) ax:: ( )
Tub /shower / shower pan 16.60
E -mail:
Urinal / 1
CONTRACTOR Water closet / 16160
Business name: Water heater 16.6,0
Address: Other:
Subtotal
City /State /ZIP: I Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized si ature: y State surcharge (8% of permit fee)
1e / /�I TOTAL PERMIT FEE
Print name: P/�OL f 1 ' , I/4/ Date: , j /Q 9 This permit application expires if a permit is not obtained within
G 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits\PLM - PermitApp.doc 12/27/06 440- 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, 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
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:
Are you capping, adding or replacing fixtures? If "yes ", ` Plan. Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture"Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing - engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918- 780 -0040.
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser_Diagram "
Floor Drain /sink - 2" ❑ Isometric or riser diagram is required fcr new buildings
that meet the qualifications above.
-4"
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
wrS aC7C.57 — CIV t t �7
,R TTJRN RECORDED DOCUMENT TO:
/CITY HALL RECORDS DEPARTMENT, .
CITY OF TIGARD
13125 SW Hall Blvd.
Tigard, OR 97223
File No. Sanitary Sewer District No. 39
City of Tigard
Sewer Reimbursement District
Deferral Agreement
City of Tigard Resolution No. 03 -55 provides that payment of certain portions of reimbursement fees
imposed on lot owners who have connected to sewers constructed through City Reimbursement Districts
(Tigard Municipal Code Chapter 13.09) may be deferred until the lot is developed.
The undersigned owner(s) of the real property described below do hereby acknowledge deferral in the 1
amount of $1,647.00 and record their agreement to pay this amount to the City of Tigard upon partitioning
or otherwise developing the property in accordance with Resolution No. 03 -55. The obligation to pay this
deferred amount transfers to purchasers upon sale of the real property.
The real property that is the subject of this agreement is Freleon Heights -Plat 2 Lot 20,Tax Lot 2S 1 2CC
1700, addressed as 10285 SW Hill View Street.
IN WITNESS WHE I hereunto set my hand on this /. day of �� , 2007
/ A ' Z C. Zifith /cU N i
�17 /14 . IS f? f r91 nd
Prim ame Print Name
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s .%az.�,r, S' rte- 2 . a -roc
Signature Signature /J
1V,,7 �I?Sg0 A 4'1 1l a16 1487 1'RSBn >` -12044
•
Address Address
s .6,/e40 CA1 9 /s_ ' L�& Oi y , @A. ga
STATE OF ('(A t CO f 6 i a
ss.
County of c-` S 11' ■ ,I •
This instrument was acknowledgedd before me on MOLL* t , 01 (date) by: t () ` E( i C [3r i -\--\-CAI 0 cod
a tt l t a Marie )'r" i -t-ki i n (name of person(s)).
D. ZAVALA "---,.2., Q
' Commisaion 170494 1 C, .110'1 C,C_
-'
.. ' Notary Public - California, Notignature
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S C� t x-� ( 1 �
� � ..,f� flan •D�� rte M y Commission Expires: � � (X,) (
1�Aprf +e[a 10ro. lid out
Accepted on behalf of the City of Tigard this q day of Mal/ , 2007
Q 4 -.-
ity Engineer
NO CHANGE IN TAX STATEMENT
i1eng\2006 -2007 fy cip\hill view 8 102nd ss dist\deferrais\deferral bnttain.doc