Permit 111 CITY OF TIGARD SEWER CONNECTION PERMIT
111 ' COMMUNITY DEVELOPMENT Permit #: SWR2013 -00118
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2013
Parcel: 1S 136AD04000
Jurisdiction: Tigard
Site address: 11527 SW PACIFIC HWY
Project: Labor Works Subdivision: VILLA RIDGE Lot: 7
Project Description: .2 EDU increase.
Contractor: Owner: PACIFIC TERRACE COMMERCIAL LLC
BY SMITH, EDITA M
833 NW 170TH DR
BEAVERTON, OR 97006
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/30/2013 $933.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .2
Total $933.00
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 503.232.19 1.800.332.2344.
Issued By: Permittee Signature: ()Ai c (0"-/
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.
I N Tenant Name: Labor Works Accumulative Sewer Tally SWR # 2013 -00118
TI G n K D Site Address: 11527 SW Pacific Hwy PLM # 2013 -00162
Parcel #: 1 S136AD04000
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 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 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:
- Lav /Bar - Non -Food Related 2 0 0 2 4 2 4
- 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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.8 12.8
,TOTALS 0 0 0 0 4 16 4 3.2
Current Fixture Value 3.2 divided by 16 = 0.200 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 3.2 divided by 16 = 0.200 over (under) $ 933.00
Enter EDU Change Here 0.200
Notes: Applied EDU credits from PLM2010- 00290.
Authorized Name /Signature: Dianna Howse Date: 5/30/2013
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
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
r
1: \ Building \ Sewer Tally \SewerTallySheet- 4665.xls 07/01/12
Accumulative Sewer Tally Parcel # 1S136AD04000
Tenant Name: SPEC SPACE This SWR# NONE
Site Address: 11527 SW PACIFIC IIWY This PLM# PLM2010 -00290
Fixture Value I'revioxi. Previous Credits Capped I;ixture 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
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 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 - Bar /Lavatory 2 0 3 6 0 -3 -6
- 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 2 12 0 -2 -12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 5 18 1 5 -4 -13
Current Fixture Value -13 divided by 16 = -0.8 Current ED 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -13 divided by 16 = -0.8 ''over (under) $ (3,280.00)
Enter EDU Change • ere -0.8 :4 1
Notes: ** *CREDITS * ** / 9/ 9 PL / &', 70 ,. >io4 /3 —6-ej /P
Authorized Name /Signature: BRANDIMTAGGARTX2449 Date: - 9/1/2010 >41
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 \SewerTallySheet- 3600.xls 06/25/08