Permit r,
il u CITY OF TIGARD SEWER CONNECTION PERMIT
l ° ; COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00287
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/20/2007
PARCEL: 25101 DA - 01900
SITE ADDRESS: 07000 SW VARNS ST ZONING: C - P
SUBDIVISION: NELSON VIAL OFFICE LOT: 003 JURISDICTION: TIG
PROJECT: NELSON VIAL
Project Description: 2.4 EDU increase.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 2.4
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner:
VIAL & PHAM FEES
7145 SW VARNS ST Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 11/20/2007 $6,720.00
•
Phone: 503 -597 -2425 Total $6,720.00
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: 4(2. Permittee Signature: Au , Ou
Call 503.639.4175 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.
• . w Accumulative Sewer Tally r. Parcel # 2S101 DA - 1900
.Tenant Name: Nelson Vial This SWR# 2007 - 00287
Site Address: 7000 SW Varnes Rd. This PLM# 2007 - 00511
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
Baptiscry/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 1 1 I 1
Eyc 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 I -IP) 16 0 0 0 0 0
- Commercial (to 5 I -IP) 32 0 0 0 0 0
- Industrial (over 5 l-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 4 8 4 8
- Bradley 5 0 0, 0 0 0
- Commercial 3 0 0 2 6 2 6
- 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 4 24 4 24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'l'OTAI 0 0 0 0 11 39 11 39
Current Fixture Value 39 divided by 16 = 2.4 Current EDU 1 EDU = S 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 39 divided by 16 = 2.4 over (under) S 6,720.00
Enter EDU Change Here 2.4
Notes.
Authorized Name /Signature: Barbara Butler Date: 11/16/2007
Building Division
Note: T1ic 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 \Sewer I'allySheet.xls 02 /02/07
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ,W"R2007 -00287
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/20/20117
Phone: (503) 639 -4171 Pw
Inspection Requests (24 Hrs.): (503) 639 -4175 ,' I �..
INSPECTION WORKSHEET FOR DATE: 11/28/2007 TIME: 7:00AM PAGE: 42
. SITE ADDRESS: 07000 SW VARNS ST CLASS OF WORK:
SUBDIVISION: NELSON VIAL OFFICE LOT #: 003 TYPE OF USE:
PROJECT NAME: NELSON VIAL
DESCRIPTION: [' Increase,
OWNER: VIAL & PHAM, I PHONE #: 503 597 - 2.425
CONTRACTOR: . PHONE #:
Inspection Request Scheduled For: Date: 11/28/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
599 Final inspection 060324 -02 503-209.7779 N
Corrections /Comments /Instructions:
Cart ft\., l B 8.
0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 01 ► /\\ Yom- Date: I I1').7 Phone #: (503) 718-