Permit CITY OF TIGARD SEWER CONNECTION PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: SWR2012 00208
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/25/2013
Parcel: 1 S134AB03300
Jurisdiction: Tigard
Site address: 10330 SW SCHOLLS FERRY RD
Project: Muslim Educational Trust Subdivision: ENGLEWOOD Lot: 88
Project Description: 20.56 EDU increase
Contractor: Owner: MUSLIM EDUCATIONAL TRUST INC
PO BOX 283
PORTLAND,OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Inspection-Commercial 11/25/2013 $45.00
Sewer Connection Fee 11/25/2013 $95,912.40
Type of Use: COM
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 20.56
Total $95,957.40
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 su •- • .r more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Those rules - - set •. OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to 0 C by calling 503.232.1•:7 of .800.332.2344.
I -ued By: ` • / Permittee Signature:
r•i
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 Sewer Tally
0
IN
p Tenant Names Muslim Education'I'rust SWR# 2012-00208
TIGnRD Site Address:,10330S\V Scholl::Ferry Rd PI,M # 2012-00204
Parcel#:'1S 134AB03300
I:ix tore 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/\Vater Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 1 4 1 4
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 4 4 4 4
Eye Wash 1 0 0 1 1 1 1
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 1 32 1 32
-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 6 12 6 12
Sink:
-Lav/Bar-Non-Food Related 2 0 0 52 104 52 104
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 5 15 5 15
Swimming Pool Filter 1 0 0 1 1 1 1
Washer-Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet-"Toilet 6 0 0 25 150 25 150
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0 0 0
Capped EDU Credit 0 0 0
'I'O"l'ALS 0 0 0 0 97 329 97 329
Current Fixture Value 329 divided by 16= 20.563 Current EDU 1 EDU= $4,665.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 329 divided by 16= 20.563 over (under) S 95,912.40
Enter EDU Change Here, 20.560
Notes: 11/6/13,(29) floor drains removed from this permit&installed under PLM2013-00400/SWR2013-00196.
Demo credits from BUP2013-00158 were applied to Pl.M2013-00400/S\VR2013-00196 on 11/6/13.
Authorized Name/Signature:'Debbie Adamski Date:; 11/6/2013
Building Division
Note: The property owner shall retain the ORIGINAL sewer rally 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.
1:\Building\Sewer Tally\Sewer I'allySheet-4665.xls 07/01/12