Permit (34) r l
CITY TIGARD SEWER CONNECTION PERMIT
i DEVELOPMENT SERVICES PERMIT #: SWR2006 - 00221
11 DATE ISSUED: 9/21/2006
13 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S136DD - 04100
SITE ADDRESS: 11850 SW 67TH AVE ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
Project Description: Building 1. New sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS: 0
' CLASS OF WORK: NEW DWELLING UNITS: 7.3
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
PACIFIC NW PROPERTIES
ATTN: PAUL GRAM Description Date Amount
P.O. BOX 2206
BEAVERTON, OR 97075 [SWUSA] Sewer Connection Fee 9/21/2006 $19,710.00
Phone: 503- 626 -3500 Total $19,710.00
Contractor:
REQUIRED ITEMS AND REPORTS
Contact #:
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 Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through
OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued by: �� i��, Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business 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.
1,
Accumulative Sewer Tally Parcel #1S136 ` ate x >t
=Tenant Name TigardTna gle Commons Blydg 1 z x 2 7 g This SWRt 2006 00 � ,
Site, Address, 11`:850 /V67th:P,kwy` >;'F4v „O'O •;k This PLM #200600412 .,;
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 _z, ;`; 0 A >, > t: 0 0 0 0
Bath - Tub /Shower 4 0 ,n 0 :g,'
,' 0 0 0
- Jacuzzi/Whirlpool 4 . 0 := 0 n f; 0 0 0
Car Wash - Each Stall 6 �. 0 "r 0 ,`,,,,, r 0 0 0
- Drive through 16 Y!:,11 ; ;WP: ” 0 A 0 rallid 0 0 0
Cuspidor/Water Aspirator 1 5'.'4',: ;Al 0 �f 0 V1,10, 0 0 0
< Y, 0
Dishwasher Commercial 4 0 0 0 0
a,
- Domestic 2 Tom^ 0 ,,,, :, ��> 0 , a ; 7 0 0 0
Drinking Fountain 1 zz,, 0 n 0 2° a 2 2 2
Eye Wash 1 ,;, 0 ilrG " 0 ::ZaWa 0 0 0
Floor Drain /Sink - 2 inch 2 0 a�, 0 ;� 1 0 5 10
- 3 inch 5 at 0 , , , 0 411. 0 05; 0 0 0
- 4 inch
- Car Wash Drr 6 UM, 0 IMO 0 •' y 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) _ 16
$i ids' 0 F, .' 0 eggc,5 0 0 0
- Commercial (to 5 HP) 32 T`' 0 > `," 0 `x us k
- Industrial (over 5 HP) 42 , z 2 `
Ice Machine /Refrigerator Drain 1 , , � 0 , , � "; t 0 :) ,: 0 0 0
Oil Sep (Gas Station) 6 1 ; 0 a, _ .:l 0 !URN 0 0 0
Rec. Vehicle Dump station 1681 0 E
xx,� �; 0 ECM M 0 0 0
Shower - Gang (per head) 1 I4 r-,2 0 tatIFI 0 ritTit 0 0 0
- Stall 2 NOM 0 MINI 0 ,1l 2 1 2
"' , ,;
Sink -Bar /Lavatory 2 0 . ;, -4 0 g, �8 16 8 16
- Bradley 5 ���1 .V,.,.. 0 0 t, x 0 0 0
- Commercial 3 , 0 ifeiM 4 tk
- Service 3 S_ s 0 till, 0 IOWA 3 1 3
Swimming Pool Filter 1 laigif 0 RY11 0 W? 0 0 0
Washer - Clothes 6 IATS.U. 0 'lam es. 0 , n' 0 0 0
Water Extractor 6 610
Water Closet - Toilet 6 . t • ; 0 ktfAile 0 Mie .; 60 10 60
Urinal 6 h s ' , 0 Dna 0` `4- ` 24 4 24
Previous EDU Count s ., 0
Capped EDU Credit v 0
TOTALS 0 0 0 0 31 117 31 117
Current Fixture Value 117 divided by 16 = 7.3 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 117 divided by 16 = 7.3 over (under) $ 19,710.00
Enter EDU Change Here 77;3• 2 '!:
Notes:
i i.
Authorized Name /Signature: < .®' ee ° Date .., :' ,, /l® ,
Building Division
(Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
is \Building \Sewer Tally \SewerTallySheet.xls 7/1/06