Permit . q
CITY F 1 I GARD SEWER CONNECTION PERMIT
■ I DEVELOPMENT SERVICES PERMIT #: SWR2006 - 00104
�� 13 125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/1/2006
PARCEL: 2S112AC - 03000
SITE ADDRESS: 14775 SW 74TH AVE ZONING: I -P
SUBDIVISION: METRO PART /MLP2002 -00008 LOT: 001 JURISDICTION: TIG
Project Description: 1.1 edu's.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.1
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
HORNEL LLC
PO BOX 159 Description Date Amount
AURORA, OR 97002
[SWUSA] Sewer Connection Fee 6/1/2006 $2,860.00
Phone: 503 - 651 -1878
Total $2,860.00
Contractor:
REQUIRED ITEMS AND REPORTS
Contact #:
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 or 1- 800 - 332 -2344.
Issued by: Permittee Signature: _7� ;/j • ,
—
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 # 2S112AC 03000,"
Tn
an Name" t ,Fa Parkes , r,r°, This SW R#k2006 00 : 11W,... ,
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!SiteAddress1,47.75,SW74th A1%V I`„ • , K", i This PLM #200,64002351 1E •.•,K .• „”; ", „ ,,
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
Baptisery/Font 4 k; ..;': 0 N,,," " ;:s 0 Iltral 0 0 0
Bath - Tub /Shower 4 ,11, 0 0 ZalliN 0 0 0
- Jacuzzi/Whirlpool 4 ,” 0 0 0 0 0
Car Wash - Each Stall 6 0 Erigrr 0 0 0 0
- Drive through 16 61311 �, 0 0 0 0 0
Cuspidor/Water Aspirator 1 < ,,,, ,, 4
p p' �� �� 0 0 0 0 0
Dishwasher - Commercial 4 s 0 0 0 0 0
Domestic 2 5,,,", 0 w 0 �', ! 0 0 0
Drinking Fountain 1 , , 1 ,?; 0 .., <,.,, 0 , , ' 0 0 0
Eye Wash 1 ,,, 0 0,11011141,0 0 e 0 0 0
-
Floor Drain /Sink - 2 inch 2 112111 0 !"1:;',4%:::? 0 11115,111 2 1 2
- 3 inch 5 TONIN 0 Nil, 0 A3tial 0 0 0
- 4 inch 6 NMI 0 0 1'a 0 0 0
- Car Wash err 6 t t ;, 0 k,„ Itakiall 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 ;
,• „ 0 ; •.• 0 0 0 0
- Commercial (to 5 HP) 32 Stilla 0 Fit6a , -- 0 liailli 0 0 0
- Industrial (over 5 HP) 42' 0 0 11,11111 0 0 0
Ice Machine /Refrigerator Drain 1 moiltraw 0 inuaggn0 0 0 0 0
Oil Sep (Gas Station) 6 NMI 0 0,•, 0 0 0
Rec. Vehicle Dump station 16 hie i;lig 0 1010111
0 IZMIR 0 0 0
Shower Gang (per head) ' -vamp:
1 r; ` xx 0 illiiiii 0 0 0 0
- Stall 2 y _.. 0 0 1 71111, 0 0 0
Sink - Bar /Lavatory 2 ig 0 i 0 Oligiiiiil 4 2 4
- Bradley 5. / ,r 0 l 0 illiClit 0 0 0
- Commercial 3 ' '':31111 0 0 11• 0 0 0
- Service 3 ,.. ,,,,M 0 Mingita 0 ?' 0 0 0
Swimming Pool Filter 1 ,, 1 0 0 11111111 0 0 0
Washer - Clothes 6 11, 0 1110 0 gegne 0 0 0
Water Extractor 6 fa ' `ffit 0 61 0 0 0 0
Water Closet - Toilet 6 0 0 1 0 ,, „ "2 , 12 2 12
a ,
Urinal 6 �;? h 0 0 0 0 0
Previous EDU Count ; 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 5 18 5 18
Current Fixture Value 18 divided by 16 = 1.1 Current EDU 1 EDU = $ 2,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 18 divided by 16 = 1.1 over (under) $ 2,860.00
Enter EDU Change Here <t_ ._ 1.1_ ".-,
Notes:
Authorized Name /Signature: Dodie',Rossgtti .a" , ,,,• -,4,11,160011 6/1/ 006 f •
Date
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
w hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i:\Building\Sewer Tally \SewerTallySheet.xls 7/1/05