Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2009 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2009
Parcel: 1 S 136CA01601
Jurisdiction: Tigard
Site address: 11665 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Keybank
Project Description: 0.9 EDU increase.
•
FEES
Owner:
HALL, DONALD W & GRACE L
&
Description Date Amount
HALL, JOHN G ET AL, BY FIRST AMERICAN Sewer Connection Fee 09/24/2009 $3,240.00
REAL ESTATE TA, 8435 N STEMMONS
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .9
Total $3,240.00
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 .. • ... -nded for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility No' cation Center. Th. -e rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You ma obtain a copy of the rules
or dire. questions to OUNC by • - I . - . 5 .246.6699 or 1.800.332.2344.
Iss. ed By: / Permittee Si. • . ure: `/ ill
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 # 1s136ca01601
Tenant Name: Keybank This SWR# 2009 - 00064
Site Address: 11665 Pacific Hwy This PLM# 2009 - 00188
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
Baptiscry/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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 1-IP) 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 Scp (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 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 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 4 14 4 14
Current Fixture Value 14 divided by 16 = 0.9 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 14 divided by 16 = 0.9 over (under) $ 3,240.00
Enter EDU Change Here 0.9
Notes:
Authorized Name /Signature: Loraine Sellers x2449 Date: 7/15/2009
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- 3600.xls 06/25/08