Permit
CITY OF TIGARD SEWER CONFECTION PERMIT
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COMMUNITY DEVELOPMENT Permit#: SWR2009-00122
. 0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/12/2009
Parcel: 2S 101 A000400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: Lot: 0
Project: NATIONAL SAFETY BUILDING
Project Description: 5.8 EDU Increase. 1/26/10, adding .5 EDU's
FEES
Owner:
NATIONAL SAFETY COMPANY Description Date Amount
17010 SW WEIR RD Sewer Connection Fee 11/12/2009 $20,880.00
BEAVERTON, OR 97007 Sewer Connection Fee 01/26/2010 $1,800.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 6.3
Total $22,680.00
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 questi to OU 6-by calling 503.246.6699 or 1.800.332.2344.
Issued B 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.
J
q CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2009-00122
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/12/2009
Parcel: 2S101 A000400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: Lot: 0
Project: NATIONAL SAFETY BUILDING
Project Description: 5.8 EDU Increase.
Owner: FEES
NATIONAL SAFETY COMPANY Description Date Amount
17010 SW WEIR RD Sewer Connection Fee 11/12/2009 $20,880.00
BEAVERTON, OR 97007
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 5.8
Total $20,880.00
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 Oreg
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 ules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: JIM ona'P J~.Wf Lu 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 thejob 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 ac00400
Tenant Name: National Safety Building, **.REVISED*** This SWR# 2009-00122
Site Address: 7095 Gonzaga This PLM# 2009-00329
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 tise /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 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 31 62 31 62
Bradley 5 0 0 0 0 0
Commercial 3 0 0 0 0 0
Service 3 0 0 2 6 2 6
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 5 30 5 30
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 39 100 39 100
Current Fixture Value 100 divided by 16 = 6.3 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 100 divided by 16 = 6.3 over (under) $ 22,680.00
Enter EDU Change Here 6.3
Notes: 1/26/10, added (1) water closet & (1) lav, for an increase of.5 EDU's. Originally collected $20, 880.00, an additional $1,800.00
as collected for a total of $22,680.00.
Authorized Name/Signature: Loraine Sellers/Debbie Adamski Date: 10/12/2009 - 1/26/10
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 Ta11y\SewerTa11ySheet-3600.x1s 06/25/08
Accumulative Sewer Tally Parcel # 2s101ac00400
Tenant Name: National Safety Building This SWR# 2009-00122
Site Address: 7095 Gonzaga This PLM# 2009-00329
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 tisc /font 4 0 0 0 0 0
Bath -Tub/Shower 4 0 0 0 0 0
acuzzi/Whirl ool 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 Drn 6 0 0 0 0 0
Garbage Disposal
Domestic to 3/4 1-11 1) 0 0 0 0 0
Commercial to 5 I-IP 32 0 0 0 0 0
Industrial over 5 1-I1142 0 0 0 0 0
Ice Machine/Rcfri rerator Drain 1 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 - Gan (per head 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar/Lavatory 2 0 0 30 60 30 60
Bradley 5 0 0 0 0 0
Commercial 3 0 0 0 0 0
Service 3 0 0 2 6 2 6
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 4 24 4 24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 37 92 37 92
Current Fixture Value 92 divided by 16 = 5.8 Current IDU 1 EDU = S 3,600
Previous fixture Value 0 divided by 16 = 0.0 Previous 13DU
Change 92 divided by 16 = 5.8 over (under) S 20,880.00
Enter EDU Change Here 5.8
Notes:
Authorized Name/Signature: Loraine Sellers Date: 10/12/2009
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.
L\Building\Sewer Tally\ Sewcrl'allySheet-3600.x1s 06/25/08