Permit CITY OF TIGARD SEWER CONNECTION PERMIT
III B COMMUNITY DEVELOPMENT Permit #: SWR2012 -00244
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/03/2013
Parcel: 1 S126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 410
Project: MacDonald Environmental Subdivision: VASHINGTON SQUARE ESTATES NO. Lot: 108
Project Description: EDU Increase of .13
Contractor: Owner: WYSE INVESTMENT SERVICES
1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: PHONE: 503 - 294 -0400
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/03/2013 $606.45
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units: 1
Number of Dwelling Units: .13
Total $606.45
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 calling 503. 2.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
Accumulative Sewer Tally
1,
Tenant Name: MacDonald Environmental SWR # 2012 -00244
Site Address: 9020 SW Washington Square Rd PI,M # 2012 -00377
1°IGARD Parcel #: 1S126BC01506
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total 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: - I iach 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
I ?yc 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 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 I IP) 16 0 0 0 0 0
- Commercial (to 5 NP) 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:
- Lav /Bar - Non -Food Related 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- C:om /Sery /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 - 'l'oilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous I ?DU Count 0 0
Capped EDU Credit 0
"I'OTAI.S 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16 = 0.125 Current I ?DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 2 divided by 16 = 0.125 over (under) S 606.45
Enter EDU Change Here 0.130
Notes:
Authorized Name /Signature: Dianna I lowse Date: 12/31/2012
Building Division
r 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.
l: \Building \Sewer Tally \SewcrTallySheet- 4665.xls 07/01/12