Permit Ii CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2006 - 00235
°' SC I ° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 4 DATE ISSUED: 10/12/2006
PARCEL: 1 S133AD -16200
SITE ADDRESS: 12700 SW NORTH DAKOTA ST 180 ZONING: C -
SUBDIVISION: PP1995 -073 LOT: 003 JURISDICTION: TIG
Project Description: 2.4 edu increase.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ADD DWELLING UNITS: 2.4
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
PACIFIC CREST PARTNERS SCHOLLS L
1430 EASTSIDE RD Description Date Amount
HOOD RIVER, OR 97031
[SWUSA] Sewer Connection Fee 10/12/200€ $6,480.00
Phone: Total $6,480.00
Contractor:
REQUIRED ITEMS AND REPORTS
Contact #:
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.
Issued by: - � �.v �„- Permittee Si gnature: — I ,� .(r1 -�, S
J
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that • siness 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 # 1S133AD -16200 k .,. • ,›
T enant Name: Quizno's This SW R# 2006 -00235
Site Address: 12700 SW North Dakota St This PLM# 2006- 0f47vaoow , :.
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 w 0 0 0
Bath - Tub /Shower 4 ,, 0 0 0
- Jacuzzi/Whirlpool 4 .4. 0 �444a o .n o o o
Car Wash - Each Stall 6 .' I , 1 .> :,
Drive through 16 � x
Cuspidor/WaterAspirator 1 0
y�� 0 � " 0 0 0
Dishwasher - Commercial 4 x 0 . .14 0 4 0 0 0
- Domestic 2 0 0 ,;y, 0 0 0
Drinking Fountain 1 . - 0 0 y 0 0 0
Eye Wash 1 '7Rl t 0 > �.• r 0 0 0 0
Floor Drain /Sink - 2 inch 2 `y 0 �x 0 4 8 4 8
` t
3 inch 5 sX. 0 y � : w 0 0 0 0
4 inch 6 '' 0 r , ° 0 �. 0 0 0 0
- Car Wash Drr 6 A .' i z - , 0 0 0 0
Garbage Disposal
Domestic (to 3/4 HP) 16 y 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 1 0 F, 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 q: •. 0 0 0 0
Sink - Bar /Lavatory 2 • 1 2 1 fil 2 6 12 6 12
- Bradley 5 0 t,:, 0 0 0 0
- Commercial 3 0 . , 0 1 3 1 3
- Service 3 .4 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 ` `
Water Closet - Toilet 6 1 A 6 .r 1 6 2 12 2 12
Urinal 6 ,,x 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 2 8 2 8 15 39 15 39
Current Fixture Value 39 divided by 16 = 2.4 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 8 divided by 16 = 0.5 Previous EDU
Change 31 divided by 16 = 1.9 over (under) $ 6,480.00
Enter EDU Change Here ;42'.4
Notes:
Authorized Name /Signature: Dodie RosSett Date: ,, -p? ' ;'
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 \SewerTallySheet.xls 7/1/06