Permit ilil 4 ' CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00283
TIGARD DATE ISSUED: 11/9/2007
13125 SW Hall Blvd., Tigant OR 97223 503.639.4171 PARCEL: 1S12600-00300
SITE ADDRESS: 09585 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: teigitilillikBWitilif SQUARE LOT: JURISDICTION: TIG
PROJECT: WASHINGTON SQUARE
Project Description: .9 EDU increase.
TENANT NAME: WASHINGTON SQUARE
CWS NO: FIXTURE UNITS: 0
CLASS OF WORK: ALT DWELLING UNITS: 0.9
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
WASHINGTON SQUARE LLC
BY THE MAC ERIC H COMPANY Description Date Amount
9585 SW WASHINGTON SQUARE RD
TIGARD, OR 97223 [SWUSA] Sewer Connection Fee 11/9/2007 $2,520.00
Phone: Total $2,520.00
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.
Issue • by: I Permittee Sin. re: %' - /
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.
Accumulative Sewer Tally Parcel # 1S12600 -00300
Tenant Na/ne Washington Square - Public Restrooms This SWR# SWR2007 - 00283
Site Address. 9585 SW Washington Square Rd This PLM# PLM2007 - 00500
I ;ix ture 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 0 0 0
I ,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 Drn 6 / 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I-IP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Scp (Gas Station) 6 0 0 0 0 0
Rcc 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 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- 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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TO A I .S 0 0 _ 0 0 5 14 _ 5 _ 14
Current Fixture Value 14 divided by 16 = 0 9 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0 0 Previous EDU
Change 14 divided by 16 = 0.9 over (under) $ 2,520.00
Enter EDU Change Here 0.9
Notes.
Authorized Name /Signature: Dianna Howse i(— Date: 11/9/2007
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 Ciry of Tigard Building Division to redeem credits towards future system development charges.
I. \Building \ Forms \Sewcrl'allyShcct 02/02/07 •