Permit r q CITY OF TIGARD SEWER CONNECTION PERMIT
' COMMUNITY DEVELOPMENT Permit#: SWR2014-00031
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/14/2014
Parcel: 2S112AA00300
Jurisdiction: Tigard
Site address: 14200 SW 72ND AVE
Project: Gerber Blades Subdivision: MILLMONT PARK Lot: 49
Project Description: 0.13 EDU increase.
Contractor: Owner: ASGARD LLC
BY GERBER LEGENDARY BLADES
14200 SW 72ND AVE
PORTLAND, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/14/2014 $624.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $624.00
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 rules a et 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 503.232.1•:7 • 1.800.332.2344. / /
I--uedBy: 1 , ./ �L 1� Permittee Signature: / /(
Call 503.639.4175 by 7:00 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.
gi Accumulative Sewer Tally
Tenant Name: GI{RBI?R Bl,.\DI?S SWR# SWR2014-00031
Site address: 1-1'_00 SW 72ND.\V I 1'l.M# PI.M2014-00099
Parcel#: 2S112M00300
Fixture \aluc I'reV iuus I'reV i 'u. , n dir. Capped l fixture Fixture New \,A
# ..Joe count I 1I'I',,I •-- v.iluc count added ti added value total#s 1..1.[I .ilii,
Baprisery/Font 4 0 0 0 0 (I
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -I?ach 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 (, (1 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4111') 16 0 (1 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
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) n 0 0 0 0 0
Rec.Vehicle Dump station 16 0 0 0 0 11
Shower: -Gang(per head) 1 0 0 0 0 0
-Stall 2 0 n 0 0 0
Sink:
-lav/Bar-Non-Food Related 2 0 0 0 0 II
-Bradley 5 0 0 0 0 0
-Cum/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 II
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 II
Urinal 6 II II 0 0 0
Previous EDU (:mini 0 0
Capped EDU Credit 0
TOTALS _ 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16= o.125 Current It: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:
Authorized Name/Signature: BR.\NDI:N'I'AGGARI'X2449 Date: 4/7/2014
Building Division
Note: The property owner shall retain the ORIGI\.\I.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\SAN er T ally\,SeewerTallySheet_48(10._070113.xlsx