Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2015-00034
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/31/2015
Parcel: 2S101 BCO2800
Jurisdiction: Tigard
Site address: 8250 SW HUNZIKER RD
Project: Centrex Subdivision: 1990-082 PARTITION PLAT Lot: 1
Project Description: .63 EDU increase.
Contractor: Owner: SEVERSON,JAMES A&ROBIN 0
29404 SW HEATER RD
SHERWOOD, OR 97140
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/31/2015 $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 adopted by the Oregon Utility otification
Center. •se rules . - set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of j: ules i1.;: t questions
to OUN by calling 503.232. 98 • . 00.332.2344.
Issu d By: / ' _ / i, Permittee Signature: /�
✓ate`.
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 compl: ion of th• • oject.
Approved plans are required on the job site at the time of each ins section.
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Accumulative Sewer Tally
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~ Tenant Name: CENTREX SWR# 2015-00034
r r C,n!t r> Site Address: 8250 SW HUNZIKER ST PLM# 2015-00099
Parcel#: 2S101 BCV02800
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 1 2 1 2
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 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) 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 1 2 0 -1 -2
Sink:
-Lay/Bar-Non-Food Related 2 0 0 2 4 2 4
-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 0 0 0 0 0
Water Closet-Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 (1 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 2 4 12 3 10
Current Fixture Value 10 _ divided by 16= 0.625 Current 11)U 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) S 3,087.00
Enter EDU Change Here 0.630
Notes:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 3/30/2015
1 Building Division
ote: The property owner shall retain the ORIGINAL 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.
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I:\Building\Sewer Tally\SewerTallySheet_4900._070114.xlsx