Permit CITY OF TIGAR® SEWER CONNECTION PERMIT
v
Q ;: COMMUNITY DEVELOPMENT Permit #: SWR2010 -00044
tr1 Date Issued: 04/07/2010
rut GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Albertsons
Project Description: 1.6 EDU increase.
FEES
Owner:
NEW ALBERTSON'S INC Description Date Amount
ATTN: 70428 - CORPORATE TAX, PO BOX 20, Sewer Connection Fee 04/07/2010 $5,760.00
250 PARKCENTER BLVD
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.6
Total $5,760.00
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 hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct que tioti to OUNC by • .Ili. • 03.246.6699 or 1.800.332.2344.
Iss ed By : ,` / Permittee Signat
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.
Accumulative Sewer Tally Parcel # 2S104BB07900
Tenant Name: - Albertsons This SWR# 2010
Sitc Address: 14300 Barrows Rd This PL,M# 2010 -00108
I ixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptistry/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
I?yc Wash 1 0 0 , 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 5, 25 5 25
- 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 1-IP) 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 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 - Bar /Lavatory 2 0 0 0 0 0
- 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
'l'OTA1S 0 0 0 _ 0 5 25 5 25
Current Fixture Value 25 divided by 16 = 1.6 Current EDU 1 EDU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 25 divided by 16 = 1.6 over (under) S 5,760.00
Enter EDU Change Here 1.6
Notes: Edited for change in scope of work.
Authorized Name /Signature: Loraine Sellers /Debbie Adamsld Date: 4/6/2010
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 \Sewcrl'allyShect- 3600.xls 06/25/08