Permit u CITY OF TIGA SEWER CONNECTION PERMIT
2 COMMUNITY DEVELOPMENT Permit #: SWR2013 00166
T LGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/30/2013
Parcel: 25111 DD00201
Jurisdiction: Tigard
Site address: 15943 SW HALL BLVD
Project: Cozy Nails & Spa Subdivision: SUMMERFIELD NO.7 Lot: N
Project Description: 2.5 EDU increase
Contractor: Owner: ROSEHILL INVESTMENTS LLC
2001 SIXTH AVE STE 2300
SEATTLE, WA 98121
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/30/2013 $12,000.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 2.5
Total $12,000.00
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. - • e rue . - 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. • : .•r 1.801 32.2344.
Is ued By: �/ 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.
Accumulative S /er Tally
4
_ 'Tenant Name: Cozy Nails & Spa SWR # 2013 -00166
TIGARD Site Address: 15943 SW Hall Blvd PI Al # 2013 -00259
Parcel #: 2S111DD00201
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 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 5 10 5 10
- 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 -1P) 32 0 0 0 0 0
- Industrial (over 5 I -1P) 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 12 24 12 24
- 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 1 6 1 6
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
TO'T'ALS 0 0 0 0 18 40 18 40
Current Fixture Value 40 divided by 16 = 2.500 Current EDU 1 EDU = $4,800.00
Previous I ixture Value 0 divided by 16 = 0.000 Previous ILDU
Change 40 divided by 16 = 2.500 over (under) S 12,000.00
Enter EDU Change Here 2.500
Notes:
Authorized Name /Signature: Debbie Adamski Date: 7/29/2013
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: A Building\ Sewer Tally \Scwcr' I'aIIySheet_4800._O7O 1 13. xIsx