Permit (17) CITY OF TIGARD SEWER CONNECTION PERMIT
N ., .
1e ' ' COMMUNITY DEVELOPMENT Permit#: SWR2023-00148
Date Issued: 6/5/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15975 SW 72ND AVE
Project: Gentle Care Massage Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: 1.25 EDU increase.Total of 1.0 EDU credits applied from PLM2016-00030 and PLM2020-00485.
Contractor: FAR WEST PLUMBING Owner: PACIFIC REALTY ASSOCIATES
PO BOX 597 ATTN: N PIVEN
ESTACADA, OR 97023 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-318-5148 PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/01/2023 $1,656.25
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .25
Total $1,656.25
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 952-0�10 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: _ Permittee Signature:
Call 5 .6 9.4175 by 7:00 a.m.for the next availab a inspection d
This permit card shall be kept in a conspicuous place on the job site until io the project.
Approved plans are required on the job site at the time of each inspection.
m Tenant Name: Gentle Care Massage
Sewer Tally SWR# 2023-00148
Site Address: 15975 SW 72nd Ave PLM# 2023-00173
TIGARD
Parcel#: 2S 112DC00701
Fixture Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 1 2 1 2
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 3 6 3 6
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 1 16
TOTALS 0 0 0 0 6 20 6 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= $6,625.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 4 divided by 16= 0.250 over (under) $ 1,656.25
Enter EDU Change Here 0.250
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: 5/30/23:CREDITS APPLIED FROM PLM2016-00030 AND PLM2020-00485.BT.
Authorized Name/Signature: Karen Abdill ext.2718 &Branden T. Date: 5/22/2023
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\Sewer Tally\SewerTallySheet_6625_070122.xIsx