Permit
. CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2009-00102
P 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/29/2009
Parcel: 2S 101 AD03200
Jurisdiction: Tigard
Site address: 12909 SW 68TH PKWY 150
Subdivision: TIGARD TRIANGLE CENTER Lot: 0
Project: Schuller Financial
Project Description: Add (.1) EDU for breakroom sink.
FEES
Owner:
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 Sewer Connection Fee 09/29/2009 $360.00
PORTLAND, OR 97224
PHONE: 503-624-6300
Contractor:
DEAN WARREN PLUMBING & REMODELING
INC
PO BOX 14701
PHONE: 503-236-4152
FAX: 503-296-2218
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .1
Total $360.00
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 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
i
Call 503.639.4175 by 7:00 a.m. for an inspection that busine 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.
- Accumulative Sewer Tally Parcel # 2s101 ad03200
Tenant Name: Schuller Financial This SWR# 2009-00102
Site Address: 12909 SW 68th Pkwy This PLM# 2009-00266
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
Ba tiser /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 0 0 0
3 inch 5 0 0 0 0 0
4 inch 6 0 0 0 0 0
Car Wash Drn 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
Oil Se Gas Station 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gan (per head 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar/Lavatory 2 0 0 1 2 1 2
Bradley 5 0 0 0 0 0
Commercial 3 0 0 0 0 0
Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16 = 0.1 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 2 divided by 16 = 0.1 over (under) $ 360.00
Enter EDU Change Here 0.1
Notes:
Authorized Name/Signature: Loraine Sellers Date:. 9/29/2009
Building Division
ote: 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.
lABuilding\Sewer Tall y\SewerTallySheet-3600.xls 06/25/08