Permit CITY OF TIGARD SEWER CONNECTION PERMIT
1 ! ' COMMUNITY DEVELOPMENT Permit#: SWR2014-00109
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/09/2014
Parcel: 1S 134BC00200
Jurisdiction: Tigard
Site address: 12186 SW SCHOLLS FERRY RD
Project: Mud Bay Subdivision: GREENWOOD TERRACE CONDO Lot: 17
Project Description: .06 EDU increase
Contractor: Owner: ATLAS GREENWAY LLC
333 NW NINTH AVE, STE 1009
PORTLAND, OR 97209
PHONE
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FEES
• Description Date Amount
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Specifics: Sewer Connection Fee 10/09/2014 $294.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .06
Total $294.00
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. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC by c g 503-:22.1987 or 1.800.332.2344.
Issue By: f Permittee Signature*
,.
(� ��wvv 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
111 Tenant Name: Mud Bay SWR# 2014-00109
Site Address: 12186 S\\'Scholls I crrc Rd PI.M# 2014-00334
Parcel#: 1S1 34BC00200
Fixture Value Pr,,t,,u- I'rcvious Credits Capped Fixture 1.ixturc \, New
∎.iluc count capped#s, value count added# added value r.,r.11 ,,, 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 ■ountain 1 0 0 0 0 (1
Eye Wash 1 0 0 0 0 (1
Floor Drain/Sink: -2 inch 2 0 0 0 0 u
-3 inch F, 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 (I
-Commercial(to 5 HP) 32 0 0 0 0 (I
-Industrial(over 5 I IP) 42 0 0 0 0 II
Ice Machine/Refrigerator Drain 1 0 0 0 0 lI
Living Unit 16 0 0 0 0 (I
Oil Sep(Gas Station) 6 0 0 0 0 (I
•
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 (I
Sink:
-Lav/Bar-Non-Food Related 2 0 1 2 0 -1 -2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothe 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 0 6 0 0 II
Previous EDU Count 0 0
Capped EDU Credit 0
,TOTALS 0 0 1 2 1 _ 3 0 1
Current Fixture Value I divided by 16= 0.u63 Current El)1 1 1:1)U = S4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 1 divided by 16= 0.063 over (under) S 294.00
Enter EDU Change Here 0.060
Notes:
Authorized Name/Signature: Dadamski Date: 10/9/2014
Building Division
Note: The property owner shall retain the ORIGIN;\. 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 fallySheet_4900._070114.xlsx