Permit •
CITY OF TIGARD SEWER CONNECTION PERMIT
' COMMUNITY DEVELOPMENT Permit #: SWR2012 -00220
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012
Parcel: 1 S133AD02200
Jurisdiction: Tigard
Site address: 10730 SW 130TH AVE
Project: Westgate Baptist Church Subdivision: HAWK'S BEARD TOWNHOMES Lot: 62
Project Description: 2nd story TI /Elevator •
•
Contractor: Owner: WESTGATE BAPTIST CHURCH
12930 SW SCHOLLS FERRY RD
TIGARD, OR 97223
PHONE: PHONE: 503 - 524 -3500
• FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/01/2012 $15,161.25
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 3.25
Total $15,161.25
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. Those rules 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 OUNC by • mg .'. 32.1987 or 1.800.332.2344.
Issued • : j /, / Permittee Signature: M (Ye-,
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
•
III r Accumulative Sewer Tally
u T enant Name: Westgate Baptist Church SWR # 2012 -00220
TIGARI7 Site Address: 10730 SW 130th Ave PI,M # 2012 -00322
Parcel #: 1 S133AD02200
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: - Mach 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 1 1
l: ye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 2 4 2 4
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 1 -1P) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 32 0 0 0 0 0
- Industrial (over 5 PIP) 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 0 4 8 4 8
- Bradley 5 0 0 0 0 0
- Com /Scrv/Util - Food Related 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water I:.xtractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 4 24 4 24
Urinal 6 0 0 2 12 2 12
Previous F.DU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 _ 0 0 14 52 14 52
Current Fixture Value 52 divided by 16 = 3.250 Current I {DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous 1 :,DU
Change 52 divided by 16 = 3.250 over (under) S 15,161.25
Enter EDU Change Here 3.250
Notes:
Authorized Name /Signature: Debbie Adamski Date: 11/1/2012
Building Division
ote: 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'allyShect- 4665.xls 07/01/12