Permit CITY OF TIGARD SEWER CONNECTION PERMIT
t COMMUNITY DEVELOPMENT Permit #: SWR2013 00145
Date Issued: 06/27/2013
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 1 S135DD03301
Jurisdiction: Tigard
Site address: 11945 SW PACIFIC HWY 238
Project: Southside Christian Fellowship Subdivision: METZGER ACRE TRACTS Lot: 9
Project Description: .13 EDU increase
Contractor: Owner: COMMERCIAL ENTERPRISES LLC
8320 NW HWY 99
VANCOUVER, WA 98665
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/27/2013 $606.45
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units:
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 adopt; 'y the Oregon Utility Notification
Center. ose rules a - set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OU by calling 503.232.1": 800.332.2344.
Is ued By: f / ` 4 v Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection daj
This permit card shall be kept in a conspicuous place on the job site until comp) • ion of the project.
Approved plans are required on the job site at the time of each Inspection.
Accumulative Sewer Tally
v
1 1111
C ; Tenant Name Southwest Christian I cllowship SWR # 2013-00145
TIGnItD Site Address. 11945 SW Pacific Hwy #238 PIAI #.2013 -00201
Parcel #• 1S135DD03301
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Bapnsery /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 \\/ash. - 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 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 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 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Scry /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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'fO'1'. \LS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided b■ 16 = 0.125 Current [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: Debbie Adamski Date:, 6/26/2013
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 \Sewer fallvShcet -4665 xls 07/01/12