Permit (152) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT
Permit#: PLM2019-00371
Date Issued: 09/24/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103CB04600
Jurisdiction:
Site address: 12190 SW MARION ST
Project: Baker Subdivision: Lot: 25
Project Description: 100'of sanitary sewer.Septic tank to be pumped and filled or removed and pump/fill receipt required at final
inspection.SRD expired 7/13/19.
Contractor: AMERICAN DRAIN CLEANING Owner:
PO BOX 3276
CLACKAMAS, OR 97015
PHONE:
PHONE: 503-265-9593
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 09/24/2019 $62.54
Specifics: 1 12%State Surcharge- 09/24/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 09/24/2019 $9.96
yp Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
Plumbing Permit Application
Building Fixtures 1 rroi' ()l b'Ici Era: f)NI,X
City of Tigard i Receiver �,k�\``"\' J C Permit No. 7" ICI.1.` A
u''-
DateB , `'�l�-
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review �;�
. p Other Permit No..
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: 'SI,y�Z-�p
T 1 G A It I7 Inspection Line: 503.639.4175 Date Ready/By: Juris: 10 See Page 2 for
Internet: www.tigard-or.gov • Notified/Method: Supplemental Information
✓,
TYPE OF WORK FEES SCHEDULE
❑New construction 0 Demolition For special information use checklist.
Description ) Qty. I Ea. I Total
"Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY.OF CONSTRUCTION SFR(1)bath 312.70
21-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION ANT)LOCATION Site utilities:
Job site address: 12_1 i l D $ �a ri A v e_. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: '1"--(C1 .a, 0 r 9 ? 2-Z
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
VL) I2-1 l .�!1_k'e + Mei,v A 5 t Rain drain connector 18.76
tT I ` Sanitary sewer(no.linear R.: Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTIONOF;WORK , Backwater valve 12.51
�j
� � Clothes washer 25.02
Co lie cTJ"vywit...e7..4�f,.,., L,-'i Dishwasher 25.02
S ct�N-4r U Drinking fountain 25.02
Ejectors/sump 25.02
.[ ,PROPERTY OWNER ElAN
TENT Expansion tank 12.51
�
j Fixture/sewer cap 25.02
Name:
,J4 n,1P� /L 5 l ik 4" 1 I Floor drain/floor sink/hub 25.02
Address: I [.j I 5 f /ni"'ie- x � .
'�" s V 'est Garbage disposal 25.02
City/State/ZIP: 3 E''k_j,j-( C g/Q 7 Hose bib 25.02
Phone:(4105 ?)2-43 LI-4 Fax:( ) Ice maker 12.51
0 APPLICANT _ iilet0IITACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
�/ Primer 12.51
Contact name: To -e P A/_tW' 61 Ls Roof drain(commercial) 12.51
Address: 30 5 4- (4-0, Sink/basin/lavatory 25.02
City/State/ZIP: c .. . 10 4,,v-k �/Q/,cie(r7 Solar units(potable water) 62.54
(3/ )) /_6c.,..5-106.- Fax::( ) Tub/shower/shower pan 12.51
Phone: 17 !t� /y �n
E-mail: 25.02
j0 j t✓e_. ba_62 G tvi a_i f. 1 o f�'`
Urinal c e 25.02
v � _al rd k� �t ale: W",. g.,..` _ • -
n
Water los t
Business name: 4 Me--rt e- -7 r-a i n C.,le tt„11 i Water piping/DWV 56.29
Address:. b )t 7 4 Other: 25.02
City/State/ZIP: C1®t'5-....
/k e_k m a y ('�? r ell Q ( - Minimum permit fee:Subtotal$72.0
Phone:(5D3 r� IEt.7 ' Tel �/ Fax:( )
r�1 Plan review (25%of permit fee)
CCB Lie.: �ft .�"1 1 i Plumbing Lia no.: State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
s Date: / This permit application expires if a permit is not obtained within 180 days
Print name: (Td r,c' , ,ir 6 ei ia, Cr I j t p f t after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard • COMMUNITY DEVELOPMENT DEPARTMENT
1111 2 r Reimbursement District Payment Worksheet
, ;,;;,,; I) 13125 SW Hall Blvd. •Tigard, Oregon 97223 • 503.718.2439 •www.tigard-or.gov
This worksheet must be completed by the Finance Department and provided
to the applicant to submit together with a completed plumbing permit
application and payment for sewer connection and reimbursement district fee,
if applicable, by expiration date shown below to the Building Division.
FINANCE DEPARTMENT TO COMPLETE:
Site Address: 12190 SW Marion Street,Tigard, OR
Reimbursement District#: 30 Parcel #:
Amount Due: $no fair share Amount Due Expires On: SRD 30 expired
Applicant: Daytime Phone:
Email Address:
El Sewer Loan Processed (journal entry to follow for payment of deferred sewer
connection fee and reimbursement district fee, if applicable)*
By: Mew Qat: 'h' Date: 09/10/2019
Name
Printed: Mai Quach
BUILDING DIVISION TO COMPLETE:
*If a sewer loan is processed, wait forjournal entry before creating plumbing and sewer permits.
Reimbursement Amount Paid: $ Receipt#: ,4f/4
SWR#: JPS 14 -.00 0.—ii-i PLM #: 020 l y-0037/
Enter parcel-renditions cede,(check all that ate:
El Enter " • ' condition.
CI ter "deferral" condition,if applicable.
By: F2-,..,. .-. Date:
Name
Printed: eF.-A„/.l-t/ /7 ,6ti4—
Attach this worksheet to issued sewer permit for records scanning.
I:\Building\Riembursement Districts\ReimDistPaymentWorksheet NoDeferredAccounts_041 91 8.docx
1
lig
TIGARD
City of Tigard
September 10,2019
RE: 12190 SW Marion Street
Tigard, Oregon
Subject: Sewer Reimbursement District No. 30
Please accept this as confirmation that the recorded instrument 2004-09-2149 for the Reimbursement
District is merely a notice of the fees required to connect to the sewer and is not a lien.
Reimbursement Districts are created in accordance with Chapter 13.09 of the Tigard Municipal Code.
Section 13.09.090 provides that
The City Recorder shall cause notice of the formation and nature of the reimbursement district to be filed in the office of the
County Recorder so as to provide notice to potential purchasers of propero within the district. Said recording shall not create
a lien.
There is no requirement to connect to a sewer constructed through a reimbursement district or pay any
fee until connection is made.The only time connection to the public sewer system would be required is
if one of two would happen (1) the septic system were to fail, (2)if the property were to develop.
This Reimbursement District expired on 7/13/2019.Therefore,no fair share costs are associated with
this district any longer. Homeowners that connect to the public sanitary system are required to pay a
connection fee and an inspection fee.
Property owners are responsible for disconnecting their existing septic system according to Washington
County rules and would be required to get a Plumbing permit from the building department.
13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171
TTY Relay: 503.684.2772 • www.tigard-or.gov