Permit 1•
CITY OF TIGARD SEWER CONNECTION PERMIT
4 s,).
COMMUNITY DEVELOPMENT Permit #: SWR2012 -00078
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/01/2012
Parcel: 1S136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST 160
Project: Benitoite Nail Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: .9 EDU increase.
Contractor: Owner: AMERICAN INDUSTRIES INC
1750 NW FRONT AVE STE #106
PORTLAND, OR 97209
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/01/2012 $4,050.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .9
Total $4,050.00
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. Thos rules ar- et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may o. -. a copy of the rules or direct questions
to OUNC by ailing 503.232.1! : r 00.332.2344. R
Issued I / / ` ' Permittee Si natur =. %
Call 503.639.4175 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 project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD SEWER CONNECTION PERMIT
r>t COMMUNITY DEVELOPMENT Permit #: SWR2012 -00078
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/01/2012
Parcel: 1 S136DCO2504
Jurisdiction: TIGARD
Site address: 7275 SW DARTMOUTH ST 160
Project: Benitoite Nail Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: TI
Contractor: Owner: AMERICAN INDUSTRIES INC
1750 NW FRONT AVE STE #106
PORTLAND, OR 97209
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/01/2012 $4,050.00
Type of Use:
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $4,050.00
' 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. T e rules a - et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUN by calling 503.232.11: o 1.800.332.2344.
Is e d By: , / / �.�iin ` f Permi ttee Signature: � (
Call 503.639.4 by 7:00 a.m. for the next available insp ection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the•ect.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
• m:
Tenant Name: Benitoite Nail SWR # 2012 -00078
TIGARD Site Address: 7275 SW Dartmouth St Ste 160 PLM # 2012 -00098
Parcel #: 1S136DCO2504
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 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 0 0 7 14 7 14
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 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 0 0 0
Urinal 6 0 _ 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 7 14 7 14
Current Fixture Value 14 divided by 16 = 0.9 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 14 divided by 16 = 0.9 over (under) $ 4,050.00
Enter EDU Change Here 0.9
Notes: - •
Authorized Name /Signature: DebbieAdamski Date: 5/1/2012
- 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
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
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