Permit Building Division
' I Applicant Request for Permit Action
City of Tigard
TO: CITY OF TIGARD, BUILDING OFFICIAL
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960
FROM: Applicant Name:
Mailing Address:
V 0 1 fl City /State /Zip:
7 f f n/n/� Phone No.:
7/5/0_5 ,e — Fax No.:
PLEASE TAKE ACTION CHECKED (1) FOR THE FOLLOWING PERMIT:
® CANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES.
Permit No.: SWR2005 -00178
Type of Permit: Sewer
Site Address: 9000 SW Durham Rd
Subdivision: Tigard High School
Lot No.:
EXPLANATION: SEE ATTACHED
Signature: Date: 7/1/05
Print Name: Dodie Rossetti
FOR OFFICE USE ONLY
Route to Admin.: Date: By:
Permit Canceled: Date: 7/.,,�'1Zz.5" By: AFEAZ
Refund Processed: Date: Ay/y- By:
Cashier Receipt: Date: #: Amnt: $
Payment Type: Per:
is \Building\Forms\RegPermitAction 09- 27- 04.doc
7/1/2005
Tags for Parcel # :2S114AA -00100 10:57:00AM
T I D E M A R K
COMPUTER SYSTEMS, INC
Use
Code Value Value Hold Description Notes Updated By
SWR N Warning Sewer EDU Tracking 5/10/04, per authorization of Gary Lampella, sewer fees 5/11/2004 DEB
were calculated and assessed for all 3 phases of the Tigard
High School addition/remodel. The end result of all the
fixture additions & capping is a net gain of .3 EDUs. This
amount was assessed on SWR2004- 00139. Deb
1 of 1
ParcelTags..rpt
•
Accumulative Sewer Tally Parcel # 2S114AA 00100
•
Tenant Name: Tigard High School This SWR# 2005 -00178
' Site Address: 9000 SW Durham Rd. This PLM# 2005 -00250
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
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 VOID
0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 ( 0 0 0
- Commercial (to 5 HP) 32 0 ? / / 17 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 0 0 0 0
- 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
TOTALS 0 0 0 0 3 11 3 11
Current Fixture Value 11 divided by 16 = 0.7 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 11 divided by 16 = 0.7 over (under) $ 1,750.00
Enter EDU Change Here 0.7
Notes:
Signature: fa - .-_ - Date: 15 1117 / 0 5
Building ivision
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