Permit CITY OF TIGARD SEWER CONNECTION PERMIT
R • - COMMUNITY DEVELOPMENT M�
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2013
V]/ Parcel: 2S102AB04800
or
Jurisdiction: Tigard
Site address: 12460 SW MAIN ST
Project: Jeffery Alan Decor Subdivision: KINGSTON Lot: 2
Project Description: 1.0 EDU increase.3/20/14,REVISED,additional capped fixtures resulted in credit of(.13)a new total of.87 EDU's
Contractor: Owner: LUONG, PETER& HIEU
113 KINGSGATE R
LAKE OSWEGO, OR 97035
PHONE: PHONE:
FAX.
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/13/2013 $4.800 00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units:
Total $4,800 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. ose ru 5- 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 OU by calling 503.'232. i or 1.800.332.2344
Ise ed By: �/IjL�Q�1 Permittee Signature st'( --i�`
__1:--- 7.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.
I
g; Accumulative Sewer Tally
Tenant Name: effery Allen Iccor-Revision 1 � / SWR# 2013-00198
Site Address: 12460 SW Main St 1Q.f,Tj IT Pl.M # 2013-00404
Parcel#: 2S102AB04800
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value t innr added # added valuv total #s total values
Baptisers/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 4) 0 0 0
- Jacuzzi/Whirlpool 4 0 11 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
1?ye Wash 1 0 0 0 0 0
Floor l)rrin/Sink: -2 inch 2 0 0 3 6 3 6
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 41 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 1W) 16 1 0 0 0 0 0
-Commercial(to 5 11P) 32 0 0 0 0 0
- Industrial(over 5 111') 42 0 0 0 0 0
Ice Machine/Refrigerator Drain I 0 0 0 0 0
Living Unit 16 0 Il 0 0 0
Oil Sep(Gas Station) 6 0 41 0 0 0•
Rec.Vehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 Il 0 0 0
-Stall 2 0 41 0 0 0
Sink:
-I.av/Bar-Non-Food Related 2 0 I 3 0 -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 it 0 0
Washer-Clothes 6 0 11 11 0 0
Water 1:xtractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 I 6 4) -1 -6
Urinal 6 0 0 0 0 0
Previous I:1.)U Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 8 3 6 1 -2
Current Fixture Value -2 divided by 16= -0.125 Current I?DU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -2 divided by 16= -0.125 over (under) S (624.00)
Enter EDU Change Here -0.130
Notes: 3/20/14,adding an additional 3 floor drains and capping(1)lav and(1)water closet. _
***CREDITS***
Authorized Name/Signature: Debbie Adamski Date: 3/20/2014
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\Sewci fallySheet_4114141._070113.xlsx
CITY OF TIGARD SEWER CONNECTION PERMIT
•. COMMUNITY DEVELOPMENT Permit#: SWR2013-00198
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11!13/2013
Parcel: 2S102AB04800
Jurisdiction: Tigard
Site address: 12460 SW MAIN ST
Project: Jeffery Alan Decor Subdivision: KINGSTON Lot: 2
Project Description: 1.0 EDU increase.
Contractor: Owner: LUONG, PETER&HIEU
113 KINGSGATE R
LAKE OSWEGO, OR 97035
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/13/2013 $4,800.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units:
Total $4,800.00
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. Those rules 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 by calling 503.232.1987 or 1.800.332.2344.
Issued By: c/ i Permittee Signature:
Call 503.639 a.m.for the next available inspection da .
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.
O
p Tenant Name: Jeffery Alan HAccumulative Sewer Tally
SWR# 2013-00198
,Is.
Site Address: 12460 SW Main St PLM# 2013-00404
F
;i C,n+�.d Parcel#:' 2S102AB04800
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 1 4 1 4
-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 1 2 1 2
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
-3inch 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 1-IP) 32 0 0 0 0 0
-Industrial(over 5 I-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 2 4 4 8 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 2 12 2 12 0 0
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 16 9 32 5 16
Current Fixture Value 16 divided by 16= 1.000 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 16 divided by 16= 1.000 over (under) $ 4,800.00
Enter EDU Change Here 1.000
Notes:
Authorized Name/Signature: Dianna Howse Date: 11/12/2013 .
Building Division
ote: 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\SewerTallyShcct_4800._070113.xlsx