Permit CITY OF TIGARD SEWER CONNECTION PERMIT
III 1 COMMUNITY DEVELOPMENT Permit#: SWR2014-00067
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2014
7[C•A R g Parcel: 2S102BD00100
Jurisdiction: Tigard
Site address: 9905 SW MCKENZIE ST
Project: St Anthony's Church Subdivision: RTH TIGARDVILLE ADDITION,AMENC Lot: 52
Project Description: .63 EDU increase
Contractor: Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
9905 SW MCKENZIE ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/10/2014 $3,087.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .63
Total $3,087.00
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 ado. •. .y the Oregon Utility Notification
Center. Thos- . -re set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain cop of the rules or direct questions
to OUNC by -Ding 503.2 .198 r 1.800.332.2344.
Issued :y:
y: ,, 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 complet on of the project.
Approved plans are required on the job site at the time of each inspection.
11 11 Accumulative Sewer Tally
Tenant Name: St Anthony's Church SWR# 2014-00067
TIGARD Site Address: 9905 SW Mckenzie St PLM# 2014-00222
Parcel#: 2S102BD00100
Fixture \ .1i 1 k Previous Previous Credits Capped Fixture Fixture New New
# \.clue count capped#s value count added# added value total#s total values
Baptisery/Font 4 U 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 U 0 0 0 0
Car Wash: -Each Stall 6 0 0 0 0 0
-Drive through 16 U 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher: -Commercial 4 U 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 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 I 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
Living Unit 16 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 I) 0 0 0
-Stall 2 0 U 1 2 1 2
Sink
-Lav/Bar-Non-Food Related 2 0 0 1 2 1 2
-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 (I 0 0 0 0
Water Closet-Toilet 6 11 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Cou n i 0 0
Capped EDU Creiii 0
TOT.\LS 0 0 0 0 3 10 3 10
Current Fixture Value 10 divided by 16= 0.625 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 10 divided by 16= 0.625 over (under) $ 3,087.00
Enter EDU Change Here 0.630
Notes:
Authorized Name/Signature: Debbie Adamski Date: 7/10/2014
Building Division
Note: The property owner shall retain the ORIGIN,\1.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\Sewer I'allySheet_491 N I._070114.xlsx