Permit n CITY OF TIGARD SEWER CONNECTION PERMIT
111111 - g COMMUNITY DEVELOPMENT Permit #: SWR2012 -00039
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/28/2012
Parcel: 2S102AA01200
Jurisdiction: Tigard
Site address: 11895 SW GREENBURG RD
Project: Luke -Dorf Inc. Subdivision: Lot: 0
Project Description: .3 EDU increase.
Contractor: Owner: LUKE -DORF INC
11895 SW GREENBURG
PORTLAND, OR 97223
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/28/2012 $1,350.00
Type of Use:
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $1,350.00
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 -0090. You may obtain a copy of the -rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued • - II ee Signature:
Call 5 c 41. by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the pr.ject.
Approved plans are required on the job site at the time of each inspection.
r Accumulative Sewer Tally
4
Tenant Name: LUKE -DORF SWR # SWR2012 -00039
TI GAAU Site Address: 11895 SW GREENBURG RD PLM # PLM2012 -00041
Parcel #: 2S 102AA01200
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptistry/Pont 4 0 0 0 0 0
Bath: - Tub /Shower 4 1 4 0 0 1 4
- 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 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 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) 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:
- Lav /Bar - Non -Food Related 2 4 8 3 6 1 2 2 4
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 1 3 1 3
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 4 24 0 1 6 5 30
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 9 36 3 6 3 11 9 41
Current Fixture Value 41 divided by 16 = 2.6 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 36 divided by 16 = 2.3 Previous EDU
Change 5 divided by 16 = 0.3 over (under) $ 1,350.00
Enter EDU Change Here 0.3
Notes:
Authorized Name /Signature: BRANDEN TAGGART Date: 2/28/2012
Building Division
Note: The property owner shall retain the ORTGINAlewer 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 \SewerTallyShcct- 4500.xls 01/18/12