Permit •
CITY OF TIGARD SEWER CONNECTION PERMIT
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1111 COMMUNITY DEVELOPMENT Permit #: SWR2011 -00068
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Date Issued: 05/11/2011
Parcel: 1S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST, STE# 100
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: 2.5 EDU's. (Credits from BUP2007 -00579 & BUP2007 -00580 applied to this permit, balance due is .5 EDU's.)
7/5/11, reprint permit to add suites 100 & 200.
Contractor: Owner: PFAFFLE OFFICE, LLC
PCCC LLC
915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/11/2011 $2,050.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .5
Total $2,050.00
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 -0090. You may obtain a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 S136CD00401
Tenant Name: I I &S .Holdings This SWR# 2011 00068, ,
Site'tldd'ress: 8020.Sw Pfaftle St, Suites 100 - 8c -200 This PLA4# 2011= 00:143 //�����
, , .. , '1/64, TO /� %n `d� /o o 1 Jf,T
Fixture Value Previous Pr ,'a -o- is ,:f.0..; Capped Fixture Fixture New New
# v �;; / -d • e ff value added added total total
co t'( ` • s count # value #s values
Baptisery /Font 4 0 "`',` , "a' ' 0 .4 w" 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- w 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 .i ,2 7 4 2 4
- 3 inch 5 ; =, 0 0 0 0 0
- 4 inch 6 ' ,;,;,. 0 :e , 0 0 0 0
- Car Wash Drn 6 0 0 ,.. 0 0 0
Garbage Disposal
- Domestic (to 3/4 1 -IP) 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 G-- 12 6 12
- 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 2, 0 0 0
Water Closet - Toilet 6 0 0 4 24 4 24
Urinal 6 • 0 h 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 2 32
TOTALS 0 0 0 0 12 40 12 8
Current Fixture Value 8 divided by 16 = 0.5 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 8 divided by 16 = 0.5 over (under) $ 2,050.00
Enter EDU Change Here ' . 0.5
Notes: EDU credits from demo permits, BUP2007 -00579 & BUP2009- 00580, applied to this permit.
Authorized Name /Signature: Debbie Adaniski ` . ' ,, . - Date: , 5/10/2011
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.
1:A Building \ Sewer Tally \Sewer 1'allyShect- 4100.xls 07/01/10
CITY OF TIGARD SEWER CONNECTION PERMIT
' '!? COMMUNITY DEVELOPMENT Permit #: SWR2011 -00068
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
T,II A • Parcel: 1 S136CD00401
Jurisdiction: TIGARD
Site address: 8020 SW PFAFFLE ST
Project: H & S Holdings Subdivision: CITY BIBLE CHURCH Lot:
Project Description: 2.5 EDU's. (Credits from BUP2007 -00579 & BUP2007 -00580 applied to this permit, balance due is .5 EDU's.)
Contractor: Owner: PFAFFLE OFFICE, LLC
PCCC LLC
915 NW TORREYVIEW LN
PORTLAND, OR 97228
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/11/2011 $2,050.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .5
Total $2,050.00
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 -0090. You may obtain a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.23• .
Issued By: � Permittee Signature:
Call r R by 7:00 a.m. for the next available inspection date.
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.