Permit CITY OF TIGARD SEWER CONNECTION PERMIT
g COMMUNITY DEVELOPMENT Permit# SWR2012 -00196
Date Issued 09/18/2012
T IGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S112AC01500
Jurisdiction Tigard
Site address 7319 SW KABLE LN 500
Project Quality Custom Distribution Services Inc Subdivision FANNO CREEK ACRE TRACTS Lot 23, PT 2
Project Description 1 38 EDU increase
Contractor Owner PACIFIC REALTY ASSOCIATES
ATTN N PIVEN
15350 SE SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE PHONE
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/18/2012 $6,437 70
Type of Use COM
Class of Work ALT
Install Type Building Sewer
Fixture Units
Number of Dwelling Units 1 38
Total $6,437 70
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 :. .en.e• more the 180 days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Cent; Those rules a = set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may o• 2 'n l a copy of the rules or direct questions
to 0 NC by calling 503 232 s : 0 800 332 2344
I hued By I 0/ l'',04409 Permittee Sign. ture \ / /`, y /
Call 503 639 4175 by 7 00 a m for the next available inspec ion gate
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project
Approved plans are required on the job site at the time of each inspection
III ` Accumulative Sewer Tally
n
I cnant Name Quality Custom Distribution Services Inc SWR # 2012 -00196
TtGAAD Site Address 7319 Sw Kablc l.n #500 PI AI # 2012 -00272
Parcel # 2S112AC01500
fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Bapuscry /Font 4 0 0 0 0 0
Bath - I ub /Shower 4 0 0 0 0 0
- jacuiii /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 1 2 1 2
- 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 I IP) 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
- I,av /Bar - Non -Food Related 2 0 0 1 2 1 2
- 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 1 6 1 6
Urinal 6 0 0 2 12 2 12
Previous I:DU Count 0 0
Capped E Credit 0
IOTA IS 0 0 0 0 5 22 5 _ 22
Current Fixture Value 22 divided by 16 = 1 375 Current I•.DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0 000 Previous I. DU
Change 22 divided by 16 = 1 375 over (under) S 6,437 70
Enter EDU Change Here 1 380
Notes
Authonzed Name /Signature. Debbie Adamski Date. 9/18/2012
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 '1 ally \Scwcrl'allyShcct -4665 xIs 07/01/12