Permit (179) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2016-00001
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/13/2016Parcel: 1 S135DA03500
Jurisdiction: Tigard
Site address: 11481 SW HALL BLVD 100
Project: HCC Subdivision: METZGER ACRE TRACTS Lot: 19
Project Description: .25 EDU increase
Contractor: Owner: BECKAL LLC
7100 SW GABLE PKWY
PORTLAND, OR 97225
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/13/2016 $1,275.00
Type of Use: COM
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 18D 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 rues Z set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OU by callingpp503.232.119 7 .8 0.332.2344. {.
I(
ey: L �' Permittee Signat
Call 503.639.4175 by 7:00 a.m.for the next available inspection
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
t
'fcnant Namc: IHY; SWR# 2016-00001
Site Address: 11481 SW hall Blvd PL\I# 2016-00014
Parcel#: 1S135DA03600
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Ba tiscry/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: -I ach Stall 6 0 0 0 0 0
-Drivc through 16 1 0 1 0 1 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
Eke Wash 1 0 0 0 0 0
FloorDrain/Sink: -2inch 2 0 0 0 0 0
-3 inch 5 0 0 0 0 0
-4 inch 6 0 0 0 0 0
-(:atWash 6 0 0 0 0 0
Garbage Disposal:
Domestic(to 3/4I P) 16 0 0 0 0 0
-Commercial (to 5 1 Ip 32 0 0 0 0 0
-
Industrial(over S ill' 42 0 0 0 0 0
Ice Ntaehine/Refri e,ator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sc Gas Station 6 0 0 0 0 0
Rcc. Vchicic DIIIIIP station 16 00 0 0 0
Shower: Gan cr head 1 0 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Belated 2 0 0 1 2 1 2
-Bradlcy 5 0 0 0 0 0
-Cum/Scry/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothe 6 0 0 0 0 0
Water ISxtraetor 6 0 0 0 0 0
Water Closet-'I oilct 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous F1RU Count 0 0
Capped FIR' Credit 0
'1OTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16= 0.250 Cmrcnt FDII 1 EDU = $5,100.00
PrcviouS I�ixtum Value 0 divided by 16= 0.000 Previous F.DU
Change 4 divided by 16= 0.250 over (under) S 1,275.00
Enter EDU Change Here 0.250 '
'Round I IDUs 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.
Notcs:
Authorized Name/Signature: Dcbbic,\damski Date: 1/13/2016
Building Division
:'utC the propern-owner shall retain the ORIGINAL sewer talk'record. I f credits exist,this document will serve as a voucher which must be
submitted ro rhe Cite of'I'igard Building Division to redeem credits towards future system development charges.
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