Permit ip . n CITY OF TIGARD SEWER CONNECTION PERMIT
` COMMUNITY DEVELOPMENT Permit# SWR2012 00189
Date Issued 09/18/2012
T f G ARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S102AA03000
Jurisdiction Tigard
Site address 8740 SW SCOFFINS ST
Project Cosale Office Subdivision TIGARD HIGHWAY TRACTS Lot 24
Project Description 25 EDU increase
Contractor Owner LANSING, ROB
17237 KELOK RD
LAKE OSWEGO, OR 97034
PHONE PHONE 503 - 544 -4673
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/18/2012 $1,166 25
Type of Use COM
Class of Work ALT
Install Type Building Sewer
Fixture Units
Number of Dwelling Units 25
.
Total $1,166 25
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 . • • .•t ed by the Oregon Utility Notification
Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain opy of the rules or direct questions
to OUNC by calling 503 232 1987 or 1 800 332 2344 _
Issued By 0� Permittee Signature
Call 503 639 4175 by 7 00 a m for the next available inspection • ate
This permit card shall be kept in a conspicuous place on the job site until com • etion o Il . oject
Approved plans are required on the job site at the time of each inspec i •
III . Accumulative Sewer Tally
I enant Name Coale Office SWR # 2012 -00189
Site Address 8740 SW Scoffin, PLNI # 2012 -00266
TIGARD Parcel # 2S102AA03000
Fixture Value Previous Previous Credits Capped Fixture l.ixture New New
# value count capped #s value count added # added value total #s total values
Baptistry /l'ont 4 0 0 0 0 0
Bath - l ub /Shower 4 0 0 0 0 0
- Jacuin /Whirlpool 4 0 0 0 0 0
Car Wash - Lath 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
kye 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 1 -11 16 0 0 0 0 0
- Commercial (to 5 I IP) 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
Rcc Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 1 2 1 2
Sink
- l.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 - Clothe, 6 0 0 0 0 0
Water l?xtractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous 1SDU Count 0 0
Capped ISDU Credit 0
1'01 ALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16 = 0 250 Current I.DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0 000 Previous I DU
Change 4 divided by 16 = 0 250 over (under) S 1,166 25
Enter EDU Change Here 0 250
Notes
Authorized Name /Signature. Debbie Adamski Date. 9/13/2012
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
submitted to the City of Tigard Building Division to redeem credits towards future system development charges
1 \ Budding \Sewer 1 ally \Sewer 1 allyShcet -4665 ors 07/01 /12