Permit _. .. .
7
,,s I n . CITY OF TIGARD
SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00247
DATE ISSUED: 9/28/2007
TtcAO. 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S1106C 01400
SITE ADDRESS: 12040 SW BULL MOUNTAIN RD ZONING: R - 4.5
SUBDIVISION: BULL MOUNTAIN VIEW ESTATES LOT: JURISDICTION: TIG
PROJECT: BULL MOUNTAIN VIEW ESTATES SUB
Project Description: Sewer connection for existing house. This permit is for collection of SDC fee only. Plumbing permit
is required when permanent connection is made.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
LOUD, ANDREW C + FEES
TAYLOR, CONTANCE J Description Date Amount
12040 SW BULL MOUNTAIN RD
TIGARD, OR 97224 [SWUSA] Sewer Connection Fee 9/28/2007 $2,800.00
Phone: Total $2,800.00
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 Utili Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of
these ru - or direct q : tions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I.sued by: i /4
Permittee Signature: y 0 Ve, i __
Call 503.639.4175 by 7:00 a.m. for an inspection that ,. sines 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.
Plumbing Permit Application . FOR' OFFICE;: USE ONLY ''r ;Fat '
•
�` r R eceived
City of Ti Permit No.. �j �2 oo 7
[ a 13125 SW Hall Blvd., Tigard, OR 97223 Re /
Date 7 O ' v J� [
;w. Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date /By: Other Permit No.:
T Inspection Line: 503.639.4175 Date Ready /By: r ® See Page 2 for
4 � IGARD fu �
.itrr:rs. pw:, Internet: www.[igard -oLgov Notified/Method: / Supplemental Information
TY PE O WORK.. _ FEE * - SCH
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition/alteration /replacement ® Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
_ CATEGORY OF CONSTRUCTION F 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
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
> JOB SITE INFORMATION AND. LOCATION;- , .;, Site utilities
Job site address: 12040 SW Bull Mt Road Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: Bull Mt View Estates 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: I Lot no.: Water service (no. linear ft.: Page 2
Fixture or item
Tax map /parcel no.: 2S1 10 BC 1400
Absorption valve 16.60
. ' DESCRIPTION -,OF WORKS Backflow preventer Page 2
Connect home to public sewer PoR y ti)U� C. Backwater valve 16.60
- i km/ r � n _ �� - £. v Clothes washer 16.60
do i%..3'. Dishwasher 16.60
Drinking 1 fountain p'longf 16.60
_
®: PROPERTY "OWNER ❑ T EN A NT
Ejectors /sump 16.60
Name: Andy Loud Expansion tank 16.60
Address: 12040 SW Bull Mt Road Fixture /sewer cap 16.60
City /State /ZIP: Tigard Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
. - Hose bib 16.60
® APPLICANT: ' -❑ CONTACT PER
Ice maker 16.60
Business name: West Hills Development
Interceptor /grease trap 16.60
Contact name: Jim Cavanaugh Medical gas (value: $ ) Page 2
Address: 735 SW 158 Avenue Primer 16.60
City /State /ZIP: Beaverton, OR 97006 Roof drain (commercial) 16.60
Phone: (503) 641 -7342 Fax: : (503) 641 -7661 Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: jcavanaugh@arborhomes.com Urinal 16.60
'CONTRACTOR` Water closet 16.60
Business name: RevCon Water heater 16.60
Address: 16655 SW Ivy Glenn Street Other:
Subtotal
City /State /ZIP: Beverton, OR 97007
Minimum permit fee: $72.50
Phone: (503) 936 -6300 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: ). •• ling Li' . no.: Plan re view (25% of permit fee) rm
State surcharge (8% of pent fee)
Authorized signature
_ TOTAL PERMIT FEE
Print name: Jim Cavanaugh Date: 9 -27 -07 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.
I:\ Building \Permits\PLM- PermitApp.doc 06/26/06 440- 4616T(10 /02 /COM/WEB)