Permit `/ 6 ' SEWER CONNECTION PERMIT
1111 n CITY OF TIGARD
e COM MUNITY DEVELOPMENT Permit #: SWR2012 00213 •
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/18/2012
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7272 SW DURHAM RD, STE# 100
Project: Indio Spirits Subdivision: COUNCIL VIEW ACRES (LOTS 21 -44) Lot: 25 -27,2:
Project Description: .19 EDU increase 11/6/2012: REVISED to increase EDU to a total of .56
Contractor: Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: PHONE: 503 - 624 -6300
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/06/2012 $2,612.40
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .19
Total $2,612.40
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. .ecialty Codes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if wor • not starte. . ithin 180 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow - rules - .opted b the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You ray obtain : copy o the rules or direct questions
to OUNC by calling 503.232.1987 1.800.332.2344.
Issued By: Permittee Sign =`�
ww C _
Call 503.639.4175 by 7:00 a.m. for the next available in .ectio , date
This permit card shall be kept in a conspicuous place on the job site un • comp ; io of the . roject.
Approved plans are required on the job site at the time of eac 'nspec '. .
Accumulative Sewer Tally plEyisED
ppi Tenant Namc: Indio Spirits ** *REVISED 11/6/12 * ** I � 6O � / I SWR # 2012 -00213
Site Address: 7272 SW Durham #100 PLM # 2012 -00303
Parcel #: 2S 112AD01000
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total 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 1 4 1 4
- 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 1 2 1 2
- 3 inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 1 -IP) 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
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:
- 1 av /Bar - Non -Food Related 2 0 1 2 0 -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 - Clothes 6 0 0 0 0 0
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
Capped EDU Credit 0
"I'OTALS _ 0 0 1 2 3 11 2 9
Current Fixture Value 9 divided by 16 = 0.563 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 9 divided by 16 = 0.563 over (under) S 2,612.40
Enter EDU Change Here 0.560
Notes: 11/6/12, adding (1) dishwasher & (1) floor sink. Not counting (1) hand sink as it is draining into the floor sink.
Authorized Name /Signature: Debbie Adamski Date: 10/18/2012
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.
1:\ Building \Sewer Tally \Sewer I'allySheet- 4665.xls 07/01/12
Accumulative Sewer Tally O R I G I N A L
u Tenant Name: Indio Spirits SWR # 2012 -00213
Site Address: 7272 SW Durham #100 PLM # 2012 -00303
TIGARD Parcel #: 2S112AD01000
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptistry/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: - I ?ach 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
lye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash 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 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 0 0 0
Sink:
- I,av /Bar - Non -Food Related 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Com /Scry /Util - Food Related 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'11 AI,S 0 0 1 2 1 5 0 3
Current Fixture Value 3 divided by 16 = 0.188 Current (EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 3 divided by 16 = 0.188 over (under) S 886.35
Enter EDU Change Here 0.190
Notes:
Authorized Name /Signature: Debbie Adamski Date: 10/18/2012
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.
l:ABuilding \Sewer Tally \Sewcr'I'allyShcct- 4665.xls 07/01 /12
V CITY OF TIGARD SEWER CONNECTION PERMIT
-
' - g '• COMMUNITY DEVELOPMENT Permit #: SWR2012 00213
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/18/2012
Parcel: 2S113AC00102
Jurisdiction: TIGARD
Site address: 7272 SW DURHAM RD, STE# 100
Project: Indio Spirits Subdivision: COUNCIL VIEW ACRES (LOTS 21-44) Lot: 25 -27,2;
Project Description: .19 EDU increase
Contractor: Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: PHONE: 503 - 624 -6300
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 10/18/2012 $886.35
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .19
Total $886.35
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 adopted by the Oregon Utility Notification
Center. • - - are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUN• by calling 503. ' . 98' s 1.800.332.2344.
Iss ed By:
4: (6/7/424(2,4•
6 /lih ll Permittee Signature , .4 lig
Call 503.639.4175 by 7:00 a.m. for the next available inspection • . e.
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.