Permit CITY OF TIGARD SEWER CONNECTION PERMIT
I II
COMMUNITY DEVELOPMENT Permit #: SWR2013 -00097
T A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/24/2013
Parcel: 251118801500
Jurisdiction: Tigard
Site address: 10362 SW MCDONALD ST
Project: CODA Subdivision: TIGARDVILLE HEIGHTS Lot: 1
Project Description: .44 EDU increase
Contractor: Owner: WASHINGTON COUNTY
SUPPORT SERVICES- FACILITIES
ATTN: TERESA WILSON
169 N FIRST AVE
HILLSBORO, OR 97124
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Sewer Connection Fee 04/24/2013 $2,052.60
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .44
Total $2,052.60
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 suspe• • • • • more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utili Notification
Center. ose rules ar• set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules • di i ct questions
to OUN' by calling 503.232 1 • : •r 1 • 332.2344.
Iss ed By: AO Permittee Signature: ■44,.
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 . the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
I Tenant Name: CODA SWR # 2013 -00097
Site Address: 10362 SW McDonald St P1.M # 2013 -00128
Parcel #: 2S111BB01500
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 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash I 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 1 2 1 2
- 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 HP) 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 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
- Com /Serv/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 Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 (I 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1) 0 3 7 3 7
Current Fixture Value 7 divided by 16 = 0.438 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 7 divided by 16 = 0.438 over (under) S 2,052.60
Enter EDU Change Here 0.440
Notes: Food prep sink is indirect to floor sink, so floor sink not included in sewer calculation.
Authorized Name /Signature: Debbie Adamski Date: 4/22/2013
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 \SewerTallvShect- 4665.xls 07/01/12