Permit • .
A , CITY OF TIGARD SEWER CONNECTION PERMIT
�; DEVELOPMENT SERVICES PERMIT #: SWR2005 -00016
� II- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/19/2005
SITE ADDRESS; 07157 SW BEVELAND RD PARCEL: 2S101AB -02100
SUBDIVISION: BEVELAND ZONING: MUE
BLOCK: LOT: 003 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.3 edu's. DEMO CREDITS FROM BUP2004 -00467 APPLIED TO THIS PERMIT.
Owner: FEES
ZIMMLER DEVELOPMENT LLC Description Date Amount
7165 SW FIR LOOP # 100
TIGARD, OR 97223 [SWUSA] Swr Connectic 1/19/2005 $3,250.00
[SWUSA] Swr Connectic 1/19/2005 $0.00
Phone: 503 -598 -3440
Total $3,250.00
Contractor:
Phone:
Reg #: LIC 00080572
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 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.
Issued by: 40 Gc �r�� �C��� Permittee
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally Parcel # 2S101AB 02100
Tenant Neme: Beveland Office Building I This SWR #2005 -00016
Site Address: 7157 SW Beveland Rd This PLM# 2005 -00022
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 c 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 r 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 2 4 2 4
- 3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 r 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 r 0 0 0 r 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 4 8 4 8
- 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 0 0 0
Water Closet - Toilet 6 0 0 3 18 3 18
Urinal 6 .: 0 0 1 ,, 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 1 16
TOTALS 0 0 0 0 10 36 10 20
Current Fixture Value 20 divided by 16 = 1.3 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 20 divided by 16 = 1.3 over (under) $ 3,250.00
Enter EDU Change Here 1.3
Notes: 1 EDU credit for demo on BUP2004 00467.
Signature: I- 222tiZ4- Ce, -u_., = �c. i / 6=:-<_ Date: (— / `7 — C
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 \SewerTallySheet.xls 7/1/04