Permit r ,, CITY OF TI GARD SEWER CONNECTION PERMIT
�� '! : 'e,:` COMMUNITY DEVELOPME Permit #: SWR2011 00130
TIGA 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/02/2011
. Parcel: 25101 BCO2401
Jurisdiction: Tigard
Site address: 12650 SW HALL BLVD
Project: Snyder Roofing Subdivision: Lot:
Project Description: .5 EDU increase.
Contractor: Owner: JFK PROPERTIES OREGON LLC
12650 SW HALL BLVD
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/02/2011 $2,250.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: ,5
Total $2,250.00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of O. Specialty ; odes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is nit started wit 'n 180 days of issuance, or if
work is sus.-.• -• or more the 180 days. ATTENTION: Oregon law requires you to follow the rules aeopted by the Oregon Utility Notification
Center. ose rules ar- et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain ': copy of the rules or direct questions
to OU by calling 503.232.198 or 1.:0:.332.2344.
Iss -d By: / /4 L e h tL_ I Permittee Signature:
I.
Call 503.639.4175 by 7:00 a.m. for the next available inspection
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
MI Tenant Name: Snyder;Roofing SWR # 2011 -00130 • .
s
Site Address: 12650 S\X 1 "r PLM # 2011-00277
. -; . Parcel #:.25,101:B;CO240i1, ,;,. _ V ,
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
f ,,. _
Baptisery/Font wz ' 0 l '' 0 ;
/Font 4 ,E 0 0 0
p Y
Bath: -Tub /Shower 4 _ _'' 0 3-._ �. 0 b , . 0 0 0
- Jacuzzi /Whirlpool 4 , g`u'ru 0 0 :, _ ;1 — 0 0 0
Car Wash: - Each Stall 6 r ; I,r � s: N „, C? 0 l y r
'. 't . 0 0 0 0
Drive through 16 , n ' 0', ��: 0 w_., 0 0 0
C'_
1 Cuspidor /Water Aspirator 1 P sM - 1 9 0 ;• ; - 0 .. ; .. 0 0 0
Dishwasher: - Commercial 4 0 � : 0 0 0 0 • - Domestic 2 � - „ � 0 � 0 �E.� - •
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 „,' 0 0 0
- 3 inch 5 0 •:, _ _ 0 't i i ; , 0 0 0
- 4 inch 6 .. 0 = 0 �. . » � ;1,, 0 0 0
- Car Wash 6 ,:`,',11,'I ` 0 441:21; ' 0 0 0
Garbage Disposal:
- Domestic (to 3/4 HP) 16 : ,, ,,, „` 0 t ` - � W� °i' 0 0 0 0
- Commercial (to 5 EIP) 32 0 , 0 • 0 0 0
- Industrial (over 5 HP) 42 ', - 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 - 0 •a ;,,•.,�'” 0 0 0 0
Oil Sep (Gas Station) 6 s i 1: „p 0 P r? -_ 0 0 0 0
Rec. Vehicle Dump station 16 --: , :,:,?.',,, - . 0 '° " : .,. - - 0 „, •' , ` 0 0 0
-
Shower: - Gang (per head) 1 ' - :
'' = „lia 0 -.) } +Ls 0 . 0 0 0
- Stall 2 .; 0 .. '';" : - 0 r . - ., 0 0 0
Sink:
- Lav /Bar - Non -food Related 2 . ._ x 0 __ _ ~, ,t. „t 0 _ .1'_' _ = 2 1 2
- Bradley 5 = ,'' 0 c ” ;,- " ( ..- 0 , ~a' : 0 0 0
- Com /Sery /Util - Food Related 3 -. 0 '1 � " #' 0 �� 0 0 0
Swimming Pool Filter 1 0 :'� 0` 0 0 0
Washer - Clothes 6 0 klll 0 ;. 0 0 0
Water Extractor 6 .'' 4 `., 0 . ' `'i; ''� �Y 0 7:••1:4,,,, °t F t ^ 1/4 ' 0 0 0
Water Closet - Toilet 6 1ti va 0 -. - o ,f4 0 '`�' .1...'. '. 1i0: ; • y 6 1 6
Urinal 6 ii'.' , :,- it 0 eF«Fh,i E ^, 0 44: J 0 0 0
Previous EDU Count '_ ' _ `,.;a 0 0
Capped EDU Credit ,, 0
TOTALS 0 0 0 0 2 8 2 8
Current Fixture Value 8 divided by 16 = 0.5 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 8 divided by 16 = 0.5 over (under) $ 2,250.00
Enter EDU Change Here' ` :0;5
Notes: Pre -fab trailer being places on property. Existing fixtures are (1) lay and (1) toilet.
Authorized Name/Signature: .'I5,ebli c t \dam i,, •, Ar :- ;s° 4 J''` s Date: 9/1/2011- •
Building Division
Note: The property owner shall retain`alieORIGINNL sewer tallysrccord. 1 f.credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits to :future system development charges.. _
I: \Building \Sewer Tally \Sewer PallySheet- 4500.xls 07/01/11