Permit rn
a CITY OF TIGARD SEWER CONNECTION PERMIT
11111 ° ... COMMUNITY DEVELOPMENT Permit #: SWR2009 -00111
Ti G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2009
Parcel: 2S112DD01400
Jurisdiction: Tigard
Site address: 15686 SW SEQUOIA PKWY
Subdivision: Lot: 0
Project: Courtyard By Marriott
Project Description: 0.9 EDU increase.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
PO BOX 58990 Sewer Connection Fee 10/27/2009 $3,240.00
SEATTLE, WA 98138
PHONE:
Contractor:
RD PLUMBING
13900 NW SPRINGVILLE RD
PORTLAND, OR 97229
PHONE: 503 - 297 -7422
FAX:
Type of Use:
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
•
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 work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notifi - . hose rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0100. You may obtain a copy of the rules
or dire uestions to OUNC b • fling 5' .2 • - . .99 or 1.800.332.2344.
I sued By: Perm ittee
Signatur 1/� 4 ��
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Call 503.639.4175 by 7:00 a.m. for an inspection that busi . • s 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 # 2s112dd01400
Tenant Name: Courtyard by Marriott This SWR# 2009 -00111
Sitc Address: 15686 Sequoia Pkwy This P1..M# 2009 -00291
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 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
I F.ye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 3 15 3 15
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 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 I -IP) 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 0 0 0
- 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 3 15 3 15
Current Fixture Value 15 divided by 16 = 0.9 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 15 divided by 16 = 0.9 over (under) $ 3,240.00
Enter EDU Change Here 0.9
Notes:
Authorized Name /Signature: Loraine Sellers 503 - 718 -2449 Date: 10/15/2009
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