Permit IN CITY OF TIGARD SEWER CONNECTION PERMIT
II COMMUNITY DEVELOPMENT Permit #: SWR2013 -00123
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2013
Parcel: 25111 BCO2603
Jurisdiction: Tigard
Site address: 10310 CANTERBURY LN
Project: East Butte Heritage Park Subdivision: TIGARDVILLE HEIGHTS Lot: 7
Project Description: 1.5 EDU's
Contractor: Owner: CITY OF TIGARD
13125 SW HALL BLVD
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/11/2013 $6,997.50
Sewer Inspection - Commercial 06/18/2013 $45.00
Type of Use: COM Reimbursement District Fee 06/11/2013 $19,213.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1.5
Total $26,255.50
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 st- • - • within 180 days of issuan . or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules - ■opte. b he Oregon Utility 'cation
Center. Those rules are set forth , in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a co. y e he rules r direct estions
to OUNC by call' 2.1987 c�1,800.332.2344.
Issued By �Vp mi l 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.
III a p Tenant Name I .ast Butte I IcritagAe Par ccumu k lative Sewer Tally SWR # 2013 -00123
TIGARD Site Address: 10310 SW Canterbury En PLM #'2013 -00174
Parcel #: 2S 111 BCO2603
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: - 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 2 • 2 2 2
Eye Wash 1 0 • 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 - 0 3 6 3 6
- 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 1 -IP) 32 0 0 0 0 0
- Industrial (over 5 1 -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:
- l,av /Bar - Non -Food Related 2 0 0 2 4 2 4
- Bradley 5 0 0 0 0 0
- Com /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 - Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TO'I'A I ,S 0 0 0 0 9 _ 24 9 24
Current Fixture Value 24 divided by 16 = 1.500 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 24 divided by 16 = 1.500 over (under) S 6,997.50
Enter EDU Change Here , 1.500
Notes:
Authorized Name /Signature: (Debbie Adamski Date: 6/6/2013
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. I f 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'allkShcet- 4665.xIs 07/W /12