Permit CITY OF TIGARD SEWER CONNECTION PERMIT
1, COMMUNITY DEVELOPMENT Permit #: SWR2013 -00150
T I G ARE' 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 06/27/2013
Parcel: 2S 101 AD02400
Jurisdiction: TIGARD
Site address: 12753 SW 68TH AVE
Project: George Fox University Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: 13 EDU increase
Contractor: Owner: GEORGE FOX UNIVERSITY
ATTN: FINANCIAL AFFAIRS
414 N MERIDIAN
NEWBERG, OR 97132
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: Building Sewer
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 rul- : . do. ed by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may op . .•py o the ule , direct questions
to OUNC by callin 2.1987 or 1.800 332 2344.
Issued By: � �� - d „ Permittee Signature: t, fe �`
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.
Accum ulative Sewer Tally
0
p Tenant Name George I ox University SWR # 2013 -00150
Site Address 12753 SW 68th Ave PLNI # 2013 -00210
TIGARD
Parcel # 2S101AD02400
Fixture Value Previous Previous Credits Capped Fixture l fixture New New
# value count capped #5 value count added # added value total #s total values
Baptiser' /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
Eve 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 HP) 32 0 0 0 0 0
- lndustnal (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 /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 - 'l'oilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16 = 0.125 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0 000 Previous I DU
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: 6/27/2013
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.
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