Permit a
CITY OF TIGARD SEWER CONNECTION PERMIT
° ` COMMUNITY DEVELOPMENT PERMIT #: SWR2008 -00048
TIGARD DATE ISSUED: 5/7/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S104AD - 04500
SITE ADDRESS: 12617 SW WALNUT ST ZONING: R -4.5
SUBDIVISION: TVF &R FIRE STATION LOT: JURISDICTION: TIG
PROJECT: TUALATIN VALLEY FIRE AND RESCU
Project Description: 10.6 EDU increase.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 10.6
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
TUALATIN VALLEY FIRE & RESCUE
20665 SW BLANTON ST Description Date Amount
ALOHA, OR 97007
[SWUSA] Sewer Connection Fee 4/25/2008 $29,680.00
Phone: 503- 649 -8577
Total $29,680.00
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
Iss d by: Permittee Signatu e: /
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.
.t Accumulative Sewer Tally Parcel # 2S104AD -04500
Tenant Name: TUALATIN VALLEY FIRE & RESCUE This SWR# SWR2008 - 00048 l I
Site Address: 12617 WALNUT RD. This PLM# PLM2008 - 00194
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 2 2 2 2
Eyc Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 2 4 2 4
- 3 inch 5 0 0 3 15 3 15
- 4 inch 6 0 0 3 18 3 18
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 1 16 1 16
- Commercial (to 5 1 -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
Rec Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 5 10 5 10
Sink - Bar /Lavatory 2 0 0 9 18 9 18
- Bradley 5 0 . 0 0 0 0
- Commercial 3 0 0 5 15 5 15
- Service 3 0 0 2 6 2 6
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 8 48 8 48
Urinal 6 0 0 2 12 2 12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 _ 0 0 43 _ 170 43 170
Current Fixture Value 170 divided by 16 = 10 6 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 170 divided by 16 = 10.6 over (under) $ 29,680.00
Enter EDU Change Here 10.6
Notes.
Authorized Name /Signature: BRANDEN TAGGARI' Date: 4/17/2008
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 Tally \Sewer I'allySheet -2008 xis 06/30/07