Permit 1 r �� CITY OF TIGARD SEWER CONNECTION PERMIT
11 COMMUNITY DEVELOPMENT Permit #: SWR2013 -00144
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Date Issued: 06/26/2013
Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 115
Project: Davidson Benefits Planning Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: .25 EDU increase.
Contractor: Owner: PORTLAND SW CENTER LLC
BY FELTON PROPERTIES INC
ATTN FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/26/2013 $1,166.25
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 25
Total $1,166.25
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 Tho 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 • calling 503.' 2 198 or 1.800.332 2344.
Issue • By: 40.4; Permittee Signature:
Call 503.639.4175 by 7:00 a.m, for the next available inspectio 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.
Accumulative Sewer Tally
III a
p ,,>. Tenant Name. Davidson Benefits Planning SWR # SWR2013 -00144
fil , , a4 Site Address. 7632 SW Durham Rd., Ste. 115 PLM # PLM2013 -00200
�`T' IG'A�R`pI
: �'dP Parcel #:, 2S113BA00400
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 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 I -IP) 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 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
TOTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16 = 0.250 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 4 divided by 16 = 0.250 over (under) $ 1,166.25
Enter EDU Change Here 0.250
Notes:
Authorized Name /Signature:,Dianna Howse Date:' 6/24/2013
Building Division
r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I•\ Building\ Sewer Tally \Sewer 1'allyShect- 4665.xIs 07/01/12