Permit I
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114 4 CITY OF TIGARD SEWER CONNECTION PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: SWR2008 -00150
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/7/2008
PARCEL: 1 S136CD -00500
SITE ADDRESS: 08050 SW PFAFFLE ST 100 ZONING: C -
SUBDIVISION: PACIFIC CROSSROADS CORP LOT: JURISDICTION: TIG
PROJECT: FBR
Project Description: 1.5 EDU Increase.
TENANT NAME: FBR
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.5
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
FBR FEES
10300 SW GREENBURG RD Description Date Amount
SUITE 375
TIGARD, OR 97223 [SWUSA] Sewer Connection Fee 11/7/2008 $4,650.00
Phone: 503- 647 -5416 Total $4,650.00
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 - - s= fo in OAR 952 - 001 -0010 t • •
OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by ca • :03.24:.6699 or 1.8! i '32.
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Issued by: / /� Permittee Signature: A � ` ��
Call 503.639.4175 by 7:00 a.m. for an inspect! n that busin ss day.
This permit card shall be kept in a conspicuous place on the job - ite until c . mpletion of the project.
Approved plans are required on the job site at the time ; eac inspection.
Accumulative Sewer Tally Parcel # 1S136CD - 00500
Tenant Name: FBR This SWR# SWR2008 - 00150
Site Address: ,8050 SW PFAFFLE SUITE 100 This PLM# PLM2008 - 00423
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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 1 4 1 4
- 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 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 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 - Bar /Lavatory 2 0 0 3 6 3 6
- 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 7 24 7 _ 24
Current Fixture Value 24 divided by 16 = 1.5 Current EDU 1 EDU = $ 3,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU '
Change 24 divided by 16 = 1.5 over (un er) $ 4,650.00
Enter EDU Change Here 1.5
Notes:
Authorized Name /Signature: BRANDEN TAGGART Date: 11/4/2008
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. I( 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- 3100.xls 06/19/08