Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY. DEVELOPMENT Permit #: SWR2012 -00070
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision: RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: 2.3 EDU's. 2.1 EDU credits used from previous demo work.
Contractor: Owner: BENNETH, CATHERINE MCNICOL
3830 ROBIN CREEK LN
WEST LINN, OR 97068
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/20/2012 $10,350.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
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Fixture Units: 23
Number of Dwelling Units: 2.3
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Total $10,350.00
Required Items and Reports (Conditions)
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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 ma •btai a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: • / i Permittee Signature: d lad Ai Vil
Call 5' 5 by 7:00 a.m. for the next available inspectio • • 1
This permit card shall be kept in a conspicuous place on the job site until • mpletio of the project.
Approved plans are required on the job site at the time of ea. insp • : ion.
Accumulative Sewer Tally
III q
o Tenant Name: BURGERVILLE SWR # SWR2012 -00070
TI.GARD Site Address: 12785 SW PACIFIC HWY PI ,IM # PLM2012 -00089
Parcel #: 2S102BD00701
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total 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 1 4 1 4
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eve Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 10 20 10 20
- 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 1 -IP) 16 0 0 0 0 0
- Commercial (to 5 I-IP) 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 0 0 2 4 2 4
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 6 18 6 18
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 3 18 3 18
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 2.1 33.6
I'OTAI S 0 0 0 0 23 70 23 36.4
Current Fixture Value 36.4 divided by 16 = 2.3 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 36.4 divided by 16 = 2.3 over (under) S 10,350.00
Enter EDU Change Here 2.3
Notes: 2.1 EDU credits from previous demo work. 2 food prep sinks indirect drain into floor sinks, so floor sinks not calculated, 1 inee maker drain is
indirect so ice maker is not calculated. (Only calculate the fixture with the greater unit value).
Authorized Name /Signature: Debbie Adamski / Branden Taggart . Date: 4/18/2012 , 4/20/12012
Building Division
ote: 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 I'allySheet- 4500.xls 01/18/12