Permit f '
4v} ` CITY OF TIGARD SEWER CONNECTION PERMIT
' COMMUNITY DEVELOPMENT Permit #: SWR2009 -00106
T 'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2009
Parcel: 2S109AB15400
Jurisdiction: Tigard
Site address: 14165 SW ALPINE CREST WAY
Subdivision: ALPINE VIEW Lot: 35
Project: Alpine View
Project Description: Sewer connection for sales trailer and future SF.
Owner:
FEES
WEST HILLS DEVELOPMENT Description Date Amount
735 SW 158TH AVE Sewer Connection Fee 10/08/2009 $3,600.00
BEAVERTON, OR 97006 Sewer Inspection - Commercial 10/08/2009 $45.00
PHONE: 503 - 641 -7342
Contractor:
PHONE:
FAX:
Type of Use: CMS
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units: 11
Number of Dwelling Units: 1
Total $3,645.00
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 -0100. You may obtain a copy of the rules
or direct ions to • I by calling 503.246.6699 or 1.800.332.2344.
Iss ed By: I �/ Permittee Signature: ( • I! 4 iwo I
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 # 2S1109AB15400
Tenant Name: Alpine View Sales Trailer This SWR# 2009 - 00106
Site Address: 14165 SW Alpine Crest Way This PLM# 2009 - 00281
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 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 0 0 0
Eve Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 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 I -IP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 I -IP) 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
Kee 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 1 2 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- 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 0 0 0
Water Closet - Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
I'OTAI,S 0 0 0 0 3 11 3 11
Current Fixture Value 11 divided by 16 = 0.7 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 1 I divided by 16 = 0.7 over (under) $ 3,600.00
Enter EDU Change Here 1.
Notes: This connection is for a sales trailer placed on this lot prior to construction of future single family home.
Authorized Name /Signature: Debbie Adamski Date: 10/8/2009
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.
I. \ Building \Sewer Tally \Scwer'I'allyShect- 3600.xls 06/25/08