Permit CITY OF TIGARD 1 SEWER CONNECTION PERMIT
III V
1 - COMMUNITY DEVELOPMENT �" Permit#: SWR2014-00085
Date Issued: 09/11/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S109DB05900
Jurisdiction: TIGARD
Site address: 13293 SW HAZELCREST WAY
Project: Sequoia Heights,Sales Trailer Subdivision: SEQUOIA HEIGHTS Lot: 7
Project Description: Sewer connection for temporary sales trailer,1 EDU. 2/24/15,reprinted to show sewer SDC credit applied to new
SF connection,SWR2015-00015.
Contractor: Owner: LENNAR NORTHWEST INC
15060 SW 133RD AVE
TIGARD,OR 97224
PHONE: PHONE: 360-258-7900
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/04/2014 $4,900.00
Sewer Inspection-Residential 09/04/2014 $35.00
Type of Use: COM
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4,935.00
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. T • - ru es : - set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUN .y calling 503.232. •87 • .800.332.2344.
Issued By: / l l / / Permittee Signa ure: ei.if�/�L_1 L.2
Call 503.639.4175 by 7:00 a.m.for the next available inspec" n date.
This permit card shall be kept in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
INCITY OF TIGARD SEWER CONNECTION PERMIT
II
a COMMUNITY DEVELOPMENT Permit#: SWR2014-00085
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/11/2014
Parcel: 2S 109DB05900
Jurisdiction: TIGARD
Site address: 13293 SW HAZELCREST WAY
Project: Sequoia Heights,Sales Trailer Subdivision: SEQUOIA HEIGHTS Lot: 7
Project Description: Sewer connection for temporary sales trailer, 1 EDU.
Contractor: Owner: LENNAR NORTHWEST INC
15060 SW 133RD AVE
TIGARD,OR 97224
PHONE: PHONE: 360-258-7900
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/04/2014 $4,900.00
Sewer Inspection-Residential 09/04/2014 $35.00
Type of Use: COM
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4,935.00
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. Thom 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 y"calling 503.232.19:7 • .800.332.2344.
Iss ed By: / , Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection •- e.
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: Sequoia I leights Salcs'1'railer SWR# 2014-00085
Site Address: 13293 SW I lazelcrest Way PLM# 2014-00281
Parcel#: 2S 109DV05900
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 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 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 HP) 16 0 0 0 0 0
-Commercial(to 5 I IP) 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 1 16 1 16
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:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley F) 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter I 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 0 0 0 0
Urinal 6 0 6 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 16 1 16
Current Fixture Value 16 divided by 16= 1.000 Current L'Dl 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 16 divided by 16= 1.000 over (under) $ 4,900.00
Enter EDU Change Here 1.000
Notes: Per CWS,charge for 1 EDU as this will eventually be replaced by a single family residence.
Authorized Name/Signature: Debbie Adamski Date: 9/11/2014
Building Division
r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\Building\tiewer Tally\Sewell'allyShect_49(Nl._I170114.xlsx