Permit CITY TIGARD SEWER CONNECTION PERMIT '
�I I DEVELOPMENT SERVICES PERMIT #: SWR2004 -00014
f � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/2004
SITE ADDRESS; 14650 SW 97TH AVE PARCEL: 2S111AC -02700
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R - 4.5
BLOCK: LOT: 037 JURISDICTION: TIG
TENANT NAME: TWALITY MIDDLE SCHOOL
USA NO: FIXTURE UNITS: 60
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 3.8 EDU increase
Owner: FEES
TIGARD TUALATIN SCHOOL DISTRICT
6960 SW SANDBURG ST Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connectic 6/28/2004 $9,120.00
[SWUSA] Swr Connectic 6/28/2004 $0.00
Phone:
Total $9,120.00
Contractor:
Phone:
Reg #:
Required Inspections
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 Ncation Center. Those rules are set forth in OAR 952 - 001 -0010 through DAR 952 - 001 -0100. You
may o in copies of t∎ese rules o i irect questions to OUNC by calling (503) 246-669s.
Iss ed by: != `���,1� /1L!! . Permittee Signature:
Call (503 • • • -4175 by 7 :00 P.M. for an inspection needed the next business day
+ Accumulative Sewer Tally Parcel # 2S111AC -02700
' Tenant Name: Twality Middle School This SWR# 2004 -00014
Site Address: 144.50 SW • 97th Ave This PLM# 20034
Fixture Value Previous Previous Credits Capped Fixture Fixture 1 New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/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 .c. 0 0 0 0
Drinking Fountain 1 0 0 • 1 1 1 1
Eye Wash 1 0 0 ,"; 0 0 0
Floor Drain /Sink - 2 inch 2 <` 0 0 0 0 0
- 3 inch 5 ' ' 0 20 9 ., 45 5 25
- 4 inch 6 - 0 0 >" h 0 0 0
- CarWashDrn 6 0 0.! 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 , r 0 0 . i 16 1 16
- Commercial (to 5 HP) 32 � 0 0 ,, -< 0 0 0
• - Industrial (over 5 HP) 48 0 0 `r ' r
0 0 0
Ice Machine /Refrigerator Drain 1 0 0 =. f. 0 0 0
Oil Sep (Gas Station) 6 ; Ex„ 0 0 0 0 0
Rec. Vehicle Dump station 16 ,, 0 1 , 0 0 0 0
Shower - Gang (per head) 1 0�. - 0 .^t 0 0 0
- Stall 2 0 Si 0 0 0 0
4,',':--A
h
Sink - Bar /Lavatory 2 3' • l 0 0 M . 0 0 0
- Bradley 5 0 'A.'4.. 0 I 1. 0 0 0
0 ,x .; 3 ••. 4 12 3 9
Commercial 3 0� <
- Service 3 y
0 ma. x; 0 _ 3 1 3
Swimming Pool Filter 1 , '.p 0 0 x ' 0 0 0
Washer Clothes 6 0 .".i'h 0 1' 6 1 6
Water Extractor 6 ri .3 0 4,5.,, 0 0 0 0
Water Closet - Toilet 6 _l„l 0 0 0 0 0
' ,,; 0 „ , ;, ,
Urinal 6 .` 0 0 0 0
............_ .................
Previous EDU Count 0 0
Capped EDU Credit ! Y 0
TOTALS 0 0 5 23 17 83 12 60
Current Fixture Value 60 divided by 16 = 3.8 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 60 divided by 16 = 3.8 over (under) $ 9,120.00
Enter EDU Change Here ;8,
Notes:
Sig ature: l i_ 1N .,i �y Date: / ,9-
Build" g Division
Note: The property owner - stall 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 \SewerTallySheet.xls 11/19/03
.tl
Accumulative Sewer Tally Parcel # 2s ) I l A-C - 02100
Tenant NVame7,o, i;Ili AAA A Le„s,,lna,,i .dt / gc.w,44c 1 This SWR# 2 _pop /Li
Site Address: ) t.4 4.1 S"(,J a1 1 Ave, This PLM# , nn 2 _ no e. ,S 9 ,
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
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- Drive through 16 .
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 I
Eye Wash 1
Floor Drain /Sink - 2 inch 2
-3inch 5 y 9
- 4 inch 6 • .
- Car Wash Dm 6
Garbage Disposal
- Domestic (to 3/4 HP) 16 : /
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48 • •
Ice Machine /Refrigerator Drain 1 . .
Oil Sep (Gas Station) 6 •
Rec. Vehicle Dump station 16 '
Shower - Gang (per head) 1
- Stall 2
Sink - Bar /Lavatory 2 • .
- Bradley 5
- Commercial 3 i '
• - Service 3 � I
Swimming Pool Filter 1 .
•
Washer - Clothes 6 I
Water Extractor 6
Water Closet - Toilet 6 .
Urinal 6
Previous EDU Count .
_ Capped EDU Credit
TOTALS
Current Fixture Value divided by 16 = Current EDU 1 EDU = $ 2,400
Previous Fixture Value divided by 16 = Previous EDU
Change divided by 16 = - over (under) $ -
En er EDU Chan a Here n •
Notes: ` / ,, , . r t1DeLo ev : , N la L a.rv� . et-- • JJOLc ►�! -_ , ♦ ._ . , i —.- • ,
•
Name: Date:
Building Division
Note: The property owner shall retain this record for sewer credit purposes. In the event of a credit, this
document stamped "ORIGINAL" shall serve as a credit voucher and must be submitted to the City of
Tigard Building Division to redeem credit towards future system development charges.