Permit CITY OF TIGARD SEWER CONNECTION PERMIT
' s.. COMMUNITY DEVELOPMENT Permit#: SWR2013-00196
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/13/2013
Parcel: 1 S134AB03300
Jurisdiction: Tigard
Site address: 10330 SW SCHOLLS FERRY RD
Project: Muslim Educational Trust Subdivision: ENGLEWOOD Lot: 88
Project Description: 3.7 EDU's. Fixtures installed=5.5 EDU's,demo credits of 1.8 applied from BUP2013-00158.(5.5-1.8=3.7
EDU's)
Contractor: Owner: MUSLIM EDUCATIONAL TRUST INC
PO BOX 283
PORTLAND, OR 97223
PHONE: PHONE:
FAX:
• -- FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/13/2013 $17,260.50
Type of Use: COM
Class of Work: NEW
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 3.7
Total $17,260.50
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 • copy of the rules or direct questions
to OUNC by calling 503.23 1987 or 1.800.332.2344.
Issued By: Permittee Signature: 16
.
Call 503.639.4175 by 7:00 a.m.for the next available inspection •ate.
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.
IN Accumulative Sewer Tally
a
p _ Tenant Name: Muslim Educational 7'rusr SWR# 2013-00196
TIGARD Site Address:;10330 SW Scholls Ferny Rd _ PI.N1 # 2013-00400
Parcel#: 1S134AB03300
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#5 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 19 38 19 38
-3 inch 5 0 0 10 50 10 50
-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 I-IP) 32 0 0 0 0 0
-Industrial(over 5 I-I1') 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 0 0 0
-Bradley 5 0 _ 0 0 0 0
-Com/Sere/Util-Food Related 3 0 0 0 0 0
Swimming fool 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-"Toiler 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 1.8 28.8
"1'O"1'. 1,S 0 0 0 0 29 88 29 59.2
Current Fixture Value 59.2 divided by 16= 3.700 Current EDU 1 EDU= $4,665.00
Previous Fixture Value _ 0 divided by 16= 0.000 Previous[DU
Change 59.2 divided by 16= 3.700 over (under) S 17,260.50
Enter EDU Change Here, 3.70.0
Notes: 1.8 EDU credits applied from demo permit BUP201 3-001 5 8.
This work was taken out of original submittal for P1.1\12012-00204,so sewer rate from that period was used.
Authorized Name/Signature: Debbie Adamski Date: 11/6/2013
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\Scwcrl'allvShcct-4665.xIs 117/111/12