Permit •
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1111 CIT TIGARD SEWER CONNECTION PERMIT
o COMMUNITY DEVELOPMENT Permit #: SWR2009 -00069
' TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/20/2009
Parcel: 2S112DD00701
Jurisdiction:
Site address: 15800 SW UPPER BOONES FERRY RD 120
Subdivision: Lot:
Project: Jonathan Plant DVM
Project Description: 1.7 EDU increase
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Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount •
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY Sewer Connection Fee 07/20/2009 $6,120.00
#300
PHONE:
Contractor:
PHONE.
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.7
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Total $6,120.00
Required Items and Reports (Conditions) ,
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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 Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain opy . - ru -
., or direct questions to OUNC by calling 503.246 or 1.800.332.2344.
Issued By Q - ( ' `- Q Permittee Signature: /I
•Call by 7:00 a.m. for an inspection that business•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: '
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' ' Accumulative Sewer Tally Parcel # 2S1I12D000701
Tenant Name: Jonathan Plant DVM This SWR# 2009 -00069
Site Address: 15800 SW Upper Boones Ferry Rd This PLM# 2009 -00195
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
Eye 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 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 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 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 7 21 7 21
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 1 6 1 6
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
Cappcd EDU Credit • 0
TOTALS 0 0 0 0 8 27 8 27
Current Fixture Value 27 divided by 16 = 1.7 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 27 divided by 16 = 1.7 over (under) $ 6,120.00
Enter EDU Change Here 1.7
Notes: `
Authorized Name /Signature: Debbie Ada kiC Date: 7/20/2009
B [vision
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