Permit (129) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2015-00177
Date Issued: 12/16/2015
TICiARI} 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
;_ t bir,. Parcel: 2S102CB06000
Jurisdiction: Tigard
Site address: 10435 SW GRANT CT
Project: Blossom Hair Salon Subdivision: WINSOME TERRACE Lot: 4
Project Description: .25 EDU increase.
Contractor: Owner: STOKES, RYAN&WENDY
10435 SW GRANT CT
TIGARD, OR 97223
PHONE: PHONE:
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/16/2015 $1,275.00
Type of Use: SF
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .25
Total $1,275.00
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 calling 503.232.1987 or 1.800.332.234,
Issued By: _``— Permittee Signature: �- -
Call 5075 by 7:00 a.m.for the next available inspection d
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.
Iiitiptitint Accumulative Sewer Tally
III n
Tenant Name: BLOSSOM SALON SWR# 2015-00177
15 : i Site Address: 10435 SW GRAN"1'CT PI.,M# 2015-00423
i • `., Parcel#: 2S102CB06000
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count - capped#s value count added# added value total#s total values
Baptiscry/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: -1?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
Lave 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 0 0 0 0
Sink:
-I,av/liar- Non-Food Related 2 0 0 2 4 2 4
-Bradley 5 0 0 0 0 0
-Com/Scry/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
Water Closet-'l'oilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'l oTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous IVDU
Change 4 divided by 16= :'0.250 ,- over (under) S 1,275.00
Enter EDU Change Here 0.250 *
*Round I?DUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: BRANDEN'1'AGGART X2449 Date: 12/16/2015
Building Division
Note: 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.
L\Budding\SewcrTally\Sewer'I'allySheet_5100_070115.xlsx