Permit CITY TIGARD SEWER CONNECTION PERMIT
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COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00151
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/7/2008
PARCEL: 1S136CD-00500
SITE ADDRESS: 08050 SW PFAFFLE ST 110 ZONING: C -P
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SUBDIVISION: PACIFIC CROSSROADS CORP LOT: JURISDICTION: TIG
PROJECT: ACCOUNTAX
Project Description: 1.5 EDU increase.
TENANT NAME: ACCOUNTAX
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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: •
ACCOUNTAX FEES
10300 SW GREENBURG RD Description Date Amount
SUITE375
TIGARD, OR 97223 [SWUSA] Sewer Connection Fee 11/7/2008 $4,650.00
Phone: 503-619-1040 • Total • $4,650.00
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Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #: •
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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 ar; :t forth in OAR 952-1'1-0010 through
OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calli-� • 503.24. or .:00.3 .2344.
Issued by: „--- i �` _ • ermittee Signature � 1
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Call 503.639.- 75 by 7:00 a.m. for an inspection t • at bu - iness day.
This permit card shall be kept in a conspicuous place on the job sit- un -II completion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally Parcel # 1S136CD-00500
Tenant Name: ACCOUNTAX This SWR# SWR2008 - 00151
Site Address: 8050 SW PFAFFLE SUITE 110 This PLM# PLM2008 - 00424
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 (u der) $ 4,650.00
Enter EDU Change Here 1.5
Notes:
Authorized Name /Signature: BRANEN TAGGART Date: 11/4/2008
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 \ SewerTallyShect-3100.xls 06/19/08