Permit CITY TIGARD SEWER CONNECTION PERMIT
,� DEVELOPMENT SERVICES PERMIT #: SWR2003 -00200
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/26/03
SITE ADDRESS; 13375 SW HOWARD DR PARCEL: 2S103CA -00600
SUBDIVISION: WOODCREST ZONING: R - 4.5
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: sewer reimbursement district No. 22
$6000 paid on receipt 2731
Owner:
FEES
MAY WILLIAM A
13375 SW HOWARD DRIVE Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connect 6/26/03 $2,300.00
[SWUSA] Swr Connect 6/26/03 $0.00
Phone: [ SWINSP] Swr Inspect 6/26/03 $35.00
[SWINSP] Swr Inspect 6/26/03 $0.00
Contractor:
Total $2,335.00
Phone:
Reg #:
Required Inspections
Sewer Inspection
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" Perm
•
Issued by: Permittee Signature: M
Call (503) 63' -4175 by 7:00 P.M. for an inspection needed the next business day
isuiiaing r fixtures
g Permit Application FOR OFFICE USE ONLY
�� R ece i ve d .ElkimlioigS a (73
Date/By: Permit No.: o V oZ. 0 0
Cit of TI and Planning Approval Sewer
Y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
//x � ' di € + � Date/B Case No.:
Internet: www.ci.tigard.or.us ' �' ( y See Page 2 for
Contact Juris.:
24 -hour Inspection Request: 503- 639 - 4175 Name /Method: Supplemental Information.
z;.r. ° °�= �' , ",�". ''�.-': '?"` - `"�� < ^ 2`�:': „¢ � ;. �. E�. ,,€;.'^��- - �:'ii' _ .,Et �:;�'�:�<- :...:-� cas. r'.�z.��'a'sN �� zno.eix^�}a'
:;. - -� TAY x2:980 K .A, i �r t FEE S00IPttg for special tnformati itise eirai "st
r- �x.�c.s..��ia, ��: ::��i: �: . =P�E'3.. � .,','�_..`+,�`..a. rte'= ;'.,'.tea».• �< '.( _ � .),is€v'�.��
❑ New construction ❑ Demolition Description • - 1 Qty. I Fee(ea.) I Total
New 1 & 2 family, ai- � _`' `
[I Addition/alteration/replacement ❑Other �,�� �� � �.. . c :; ���, ��,;� �.� ��
"fi t. � CATEGORY QF CONSTRUCTION ; c 4 .... _,,, ' ��' " - 4.'(includes 100eft for eah uity: connection) .
fir° -'� SFR (1) bath 249.20
4 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
•
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
;;;. `. JOB;SIT»E,INFORMATION and LO:CAThON_ ' g'= »;« Fire sprinkler - sq. ft.: Page 2
Job site address: 1337 Sco He,a&,4.4-J 0r km: _,A` �,� �'W z?,CSlteI"ltllii S: ` al , SM
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line /trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
`,c t.t.) (2,1 5 4- Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no linear ft.) Page 2
„,'v; .... =T.a, ?'� .,E ". ,: .a_ ., .., :v ''.' €:... �:^Eawu =t, a�. all FIX CCQ,�r, ItC ''- r „� �'r.k.' 7;777
. ;.; 5 . ' » ; DS OF W,OWSVE a liM ;:' Absorption valve 16.60
S ec-t . er r e re- eq,Sern -`+'i 72 2 Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
'ROPER OWNER ; - ril T? 'ENANT'' =p`.5' °, _ ; ; , ;<
Drinking fountain 16.60
TI'S a .s;�, ,�.,�.:.:::,. �h. Ejectors/sump 16.60
Name: CAc9, (61,, ill 4 Expansion tank 16.60
Address: / 3 3 7 S S w 4 w4 -ref br . Fixture /sewer cap 16.60
City /State /Zip: T. Qr� c 2 c 7 2 3 Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: s'o m S' 90 - St o 1 Fax: Hose bib 16.60
tOPLICANT a . ra a rooszkauto(sAmili Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip: Ro mer 16.60
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
-- ;�t. ::.. ;�-:,� Urinal 16.60
� �,� `� :�z � rsCONTRAGTOR ° °=;;�� � �.,��..�' :< -�:
Business Name: Water close 16.60
Water heater 16.60
Address: . Other:
City /State /Zip: Other:
Phone: Fax: r w lriVMMMPluuibinglPecnillFee SZS i:.
Subtotal $
CCB Lic. #: Plumb. Lic. #:
Authorized Minimum Permit Fee $72.50 $
q R esiden tial Backflow Minimum Fee $36.25
Signature: "C m Date: ^ 2 G- 03 Plan Review (25% of Permit Fee) $
L, t II i / . {&Yl 4 1/4.. ! f State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms\P1mPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information ' •
Fee Schedule: Residential Fire Suppression
aS 0 tllttes' QtY F.ee (ea) Iotal s eII pr Systems: : .. .. ..
>< up e
: ... H L ::.�. E, . quare Fo °` , b i Perrn><trFee r
Footing drain - 100' 55.00 0 to X000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer - 1st 100' 3,601 to 7,200 $220.00
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
N
Valuat>on :MW :,
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum feel $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
. additional $100.00 or fraction thereof, to and
•F" - :, } `izture or xtgn3 �. : Mk? 00:*),fi , Total F
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 +' acid 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:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
......
Quant�tybyo (F_istare).WorkaPerformeit ": Comments regarding fixture work:
Fixture Type 4 Replace
Moyed LE-ago ,,,,Gapped " .
Baptistry/Font
Bath •- Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
•
-Drive Thru .
Cuspidor /Water Aspirator •
Dishwasher - Commercial
- Domestic
•
Drinking Fountain -
Eye Wash
Floor Drain/sink - 2"
- 3"
4 „ •
Car Wash Drain
Garbage Domestic *Note: If the fixture work under this permit results in an
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor .
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts'Permit FormslPlmPermitAppPg2.doc 01/03
5 0733 —ooc;_ c31
CITY OF TIGARD, OREGON
RESOLUTION NO. 02- OS
A RESOLUTION FINALIZING SANITARY SEWER REIMBURSEMENT DISTRICT NO. 22
(HOWARD DRIVE)
WHEREAS, on March 12, 2002, the City Council approved Resolution No. 02 -18 to form Sanitary Sewer
District No. 22 to construct sewers in SW Howard Drive in accordance with TMC Chapter 13.09; and
WHEREAS, Resolution No. 02 -18 included the City Engineer's Report that included an estimated
construction and total project cost; and
T ,
WHEREAS, construction of the sewer improvements has completed, final costs have been determined and
the City Engineer's Report has been revised to include the final costs as required by TMC 13.09.105 (1);
and •
WHEREAS, these property owners have been notified of an informational hearing in accordance with TMC
13.09.060 and an informational hearing was conducted in accordance with TMC 13.09.105; and
WHEREAS, the City Council has determined that the proposed revisions to the City Engineer's Report as
recommended by the City Engineer are appropriate.
NOW, THEREFORE, BE IT RESOLED by the Tigard City Council that:
SECTION 1 . The revised City Engineer's Report titled "Sanitary Sewer Reimbursement District
No. 22 ", attached hereto as Exhibit A, is hereby approved.
SECTION 2 Resolution No. 02 -18 is hereby amended to add the revised City Engineer's Report.
SECTION 3 The City Recorder shall cause a copy of this resolution to be filed in the office of the
County Recorder and shall mail a copy of this resolution to all affected property
owners at their last known address.
EFFECTIVE DATE: This resolution shall be effective immediately.
PASSED: This
_ ( -1:1-1 day of D�L,0 2002.
M : yor - City . f Tig.
ATTEST:
City Recorder = City of Tigar• • • /- •
V
RESOLUTION NO. 02- Co
Page 1
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