Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00192
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/17/2007
PARCEL: 1S136DC-04400
SITE ADDRESS: 11945 SW 70TH AVE ZONING: C -G
SUBDIVISION: DARTMOUTH SQUARE LOT: 030 JURISDICTION: TIG
PROJECT: DARTMOUTH SQUARE
Project Description: 8.6 EDU increase Building fixtures.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 8.6
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
DARTMOUTH SQUARE, LLC
7165 SW FIR LOOP # 100 Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 9/17/2007 $24,080.00
Phone: Total $24,080.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
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
or1 ." . 44.
I sued by: 1 £4 � 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 comple • of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally Parcel # 1S136DC -04400
Tenant Name: Dartm6uth Square This SWR# 2007 -00192
Site Address: 11945 SW 70th Ave. This PLM# 2007 -00342
I ;ixturc Value Previous Previous Credits Capped Fixture Fixture Ncw New
• # value capped off value added added total total
count off #s count # value #s values
Baptiscry/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 3 3 3 3
I'.yc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 9 18 9 18
- 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 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 9 18 9 18
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Watcr Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 12 72 12 72
Urinal 6 0 0 4 24 4 24
Previous EDU Count 0 0
Capped EDU Credit 0
TO'T'ALS 0 0 0 0 38 _ 138 38 138
Current fixture Value 138 divided by 16 = 8.6 Current EDU 1 EDU = S 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 138 divided by 16 = 8.6 over (under) $ 24,080.00
Enter EDU Change Here 8.6 •
Notes:
•
Authorized Name /Signature: Barbara Butler Date: 8/10/2007
Building Division
Nore: 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 \ Forms \Scwer•1'allyShcct.xls 02/02/07