Permit .! CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00047
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/2/2007
PARCEL: 2S113AB -00300
SITE ADDRESS: 16083 SW UPPER BOONES FERRY RD ZONING: I -L
SUBDIVISION: FANNO CREEK PLACE LOT: JURISDICTION: TIG
PROJECT: FANNO CREEK PLACE
Project Description: 9.8 edu.
TENANT NAME:
CWS NO: FIXTURE UNITS: 0
CLASS OF WORK: NEW DWELLING UNITS: 9.8
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
OPUS NORTHWEST LLC
1500 SW FIRST AVE. STE 1100 Description Date Amount
PORTLAND, OR 97201
[SWUSA] Sewer Connection Fee 3/2/2007 $26,460.00
Phone: 503- 916 -8963
Total $26,460.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
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 are set forth in OAR 952 - 001 -0010 through
OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued by: ,i Permittee Signature: /'
/ odz G7"Z/S
Call 503.639.4175 by 7:00 a.m. for an inspectio 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.
IF Accumulative Sewer Tally Parcel # 2S113AB -00300
::;: c Name: Fanno Creek Place This S WR# 2007 -00047
Site Address: 16083 SW Upper Boones Ferry Rd This PLM# 2006 -00559
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 3 3 3 3
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink - 2 inch 2 0 0 6 12 6 12
- 3inch 5 0 0 0 0 0
- 4inch 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 1 1 1 1
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 12 24 12 24
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 3 9 3 9
- 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 15 90 15 90
Urinal 6 0 0 3 18 3 18
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 43 157 43 157
Current Fixture Value 157 divided by 16 = 9.8 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 157 divided by 16 = 9.8 over (under) $ 26,460.00
Enter EDU Change Here 9.8
Notes:
Authorized Name/Signature:Dodie Rossetti Date: 9 —__,2 -Q 7
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 \Forms \SewerTallySheet.xls 02/02/07