Permit CITY TIGARD SEWER CONNECTION PERMIT
� �i'., � DEVELOPMENT SERVICES PERMIT #: SWR2004 - 00081
� .� �I" DATE ISSUED: 3/17/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 09000 SW DURHAM RD PARCEL: 2S114A0 00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: TIGARD HIGH SCHOOL
USA NO: FIXTURE UNITS: 23
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.4 EDU increase
Owner: FEES
TIGARD - TUALATIN SCHOOL DIST Description Date Amount
13137 SW PACIFIC HWY
TIGARD, OR 97224 [SWUSA] Swr Connect 3/17/04 $3,360.00
[SWUSA] Swr Connect 3/17/04 $0.00
Phone: Total $3,360.00
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" Perm
1 aaoidi
Iss d by. ) A / Permittee Signature:X 9 /-ec�n _, ./ r A w/
�- 111) 639- 75 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally Parcel # 2S114A0 -00100
Tenant n Tigard High School - Portable This SWR# 2004 -00081
Site Address: 9000 SW Durham Rd This PLM# 2004 -00101
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 1 2 1 2
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
- 3 inch 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 0 0 0 0
- Industrial (over 5 HP) 48 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 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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 7 23 7 23
Current Fixture Value 23 divided by 16 = 1.4 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 23 divided by 16 = 1.4 over (under) $ 3,360.00
Enter EDU Change Here 1.4
Notes: Per Brad Hoskins '.ar. .it ool Dist, there were no plumbing fixtures in the previous portable that po ble is replacing.
Signature: 1,. 1�1 - a ..,a .,1: 11 ! t Date. /
Building Division
Note: The prope wner 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 11/19/03