Permit f ti CITY OF TIGARD SEWER CONNECTION PERMIT
';' C OMMUNITY DEVELOPMENT Permit #: SWR2010 00090
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/30/2010
TI A, Parcel: 1S133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Subdivision: Lot: 0
Project: Westgate Baptist
Project Description: 1.8 EDU increase
FEES
Owner:
WESTGATE BAPTIST CHURCH Description Date Amount
12930 SW SCHOLLS FERRY RD Sewer Connection Fee 06/30/2010 $6,480.00
TIGARD, OR 97223
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.8
Total $6,480.00
Required Items and Reports (Conditions)'
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N ion en a Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or d ct questions to OUNC by c.1144 3p3.246.6699 3.246.6699 or 1.800.332.2344.
Issued By: j / , Permittee Signature: X A s 141 ` .
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally Parcel # 1 5 0 S _. g T i , 7.
Tenant Nam Westga erF3 ptrtit.,vaj , 2''�v a ? This SWR# 2010 -00090azz t
Si :'iq drese4t1r0730 SW 130fh Ave ';! , `3 vi . This PLM# 2010"00180" ' 0 ,
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
. # value capped off value a_ dded added total total
_ ' count off #s count ' # value #s values
'� '"�' _ Its. -'4 g . ,_:
Baptisery /Font ' 4' *ra ks T 0 0 0 0 0
Bath - Tub/Shower 4 ° 0 V_; 0 !.$ .:;. 0 0 0
- Jacuzzi /Whirlpool 4 0 Mall 0 tai2112 0 0 0
Car Wash -Each Stall 6 --_, 0 0 0 0 0
- Drive through 16 1 s, - 0 EMI' 0 °' r 5 0 0 0
Cuspidor /Water Aspirator 1 Oftlig 0 g Wiz: 0 0 0
Dishwasher - Commercial 4 EMS .. ` 0 m ,_ M 0 1 ° :t 4 1 4
- Domestic 2 `r` r„ 0 l A . 0 t „.t' , 0 0 0
Drinking Fountain 1 iggitaE, 0 0 ` i" +'" a lli 0 0 0
1yc Wash 1 VIM 0 its „ i p„ 0 201',W.' 0 0 0
Floor Drain /Sink - 2 inch 2; - 1 `? ,, 0 r.` , a; 0 ; ; 1 3 2 1 2
- 3 inch 5 012 , "'” 0i';‘,4,-,RM. 0 ,, 4_. 0 0 0
- 4 inch 6 MINI 0 a, z. 0 k 0 0 0
- Car Wash Drn • 6 VIVA 0 refol 0 0220 0 0 0
Garbage Disposal
- Domestic (to 3/4 11P) 16 Militij 0 7 0 i , r
- Commercial to , 5 HP) 3Z tifr,:,,, 0 ° d" 0 0 0
fMil a '
- Industrial (over 5 HP)' 42 ,. ,. 0 0 !71;00:4114 0 0 0
Ice Machine /Refrigerator Drain 1 _ , 0 ,1 1 1 1
0
Oil Sep (Gas Station) 6 . i ,' S 0 0 4 0 0 0
:tl m' u1, 0 ' _ 0 0 0
Rcc. Vehicle Dump station 16 �.. a t,. _ 0 �,„ ,�� ,
Shower - Gang (per head) 1 0 KfifirRE 0 s, ss, 0 0 0
- Stall 2' etital 0 HMO 0 BIM 0 0 0
Sink - Bar /Lavatory 2• „., 0 goo 0 �: 0 0 0
- Bradley 5 MAW 0 ilit;E:Mia 0 atiAgit 0 0 0
- Commercial 3 ail ry e._ 0 ° ; ,, .` F t 0 I5 15 5 15
.�ar.�
- Service 3 ParAfi 0 a s l'° i 0 .` x 0 0 0
Swimming Pool Filter 1 a2ZahAt 0 , 0 4gigWO 0 0 0
Washer Clothes 6 °`: 0 0 Wail* 0 0 0
a�a ” 5'"''" �@s e. a g : NIP 514 Water Extractor 6 0 ° ; , <wAr i 0 g „ 0 0 0
Water Closet . Toilet 6 v J 0 P13 „, r a 0 MIME 6 1 6
itsrimmmt
Urinal 6 l” 0 ;2:-: 0 ItitZillai1 0 0 0
Previous EDU Count 0 0
Capped EDU Credits "' 0
TOTALS 0 0 0 0 9 28 9 28
Current Fixture Value 28 , divided by 16 = 1.8 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 2 - - divided by 16 = 1.8 over (under) $ 6,480.00
EnterEDU Change Here al 8' ' ,
Notes: 6/30/10, original application indicated:all fixtures= were replacements. Per property owner all fixtures arc.new installs.
Authorized NAme /Signature ;-Debbie Adamtilu„ _ _ _ , q W, : °.` A '`
Date �, .�.� .:,6/30%2010....�„ �:,itoa %�;�
Building Division
Note: 'Theproperty 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: \Buil ding \Sexier Tally \Sewer"I'allySheet- 3600.xls 06/25/08