Permit CITY OF TIGARD SEWER CONNECTION PERMIT
al
71 ° COMMUNITY DEVELOPMENT PERMIT #: SWR2008 -00046
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2%C..05000 08
. PARCEL:
SITE ADDRESS: 09397 SW LOCUST ST BLDG 2 ZONING: C -
SUBDIVISION: LEHMANN ACRE TRACT LOT: 003 JURISDICTION: TIG
PROJECT: FREEMAN OFFICE BUILDING
Project Description: 1.2 EDU's for new office building.
TENANT NAME: FREEMAN OFFICE
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.2
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
COOPER MOUNTAIN VINEYARD LLC
9480 SWGRABHORN RD Description Date Amount
BEAVERTON, OR 97007
[SWUSA] Sewer Connection Fee 4/9/2008 $3,360.00
Phone: 503- 649 -0027 Total $3,360.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #: .
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 or 1.800.332.2344.
Issu d by: n ‘ .4# A i i Permittee Signature: vil/ ke th, 60 ,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Parcel # 1S126DC - 05000
Tenant Name".' Preeriian Office Building This SWR# 2008 - 00046
Site Address: 9397 SW Locust This PLM# 2008 - 00144
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 - 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 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 1 1 1 1
•
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 1 2 1 2
Sink - Bar /Lavatory 2 0 0 2 4 2 4
- 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 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 6 19 6 19
Current Fixture Value 19 divided by 16 = 1.2 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 19 divided by 16 = 1.2 over (under) $ 3,360.00
Enter EDU Change Here 1.2
Notes:
Authorized Name /Signature: Debbie Adamski Date: 4/9/2008
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 \Sewer fallySheet- 2008.xls 06/30/07