Permit (96) CITY OF TIGARD SEWER CONNECTION PERMIT
g. COMMUNITY DEVELOPMENT Permit#: SWR2016-00021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/18/2016
Parcel: 1S1260000300
Jurisdiction: Tigard
Site address: 9368 WASHINGTON SQUARE RD R03
Project: Papyrus Subdivision: None Lot: None
Project Description: .19 EDU increase
Contractor: Owner: PPR WASHINGTON SQUARE LLC
PO BOX 847
CARLSBAD, CA 92018
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/18/2016 $969.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .19
Total $969.00
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. Tho - - e 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 ••calling 503.23 19: 0 1 :10.332.2344.
Is ed By: . u.�/�`�`� Permitter Signature: iir ./• ✓��
Call 503.639.4175 by 7:00 a.m.for the next available insp- ion date.
This permit card shall be kept in a conspicuous place on the job sit- • til completion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
111 • - Tenant Name: Papyrus SWR# 2016-00021
Site.Address: 9368 SW Washington Square Rd PLM# 2016-00080
TIGARI)
Parcel#: 1S1260000300
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: -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
I:.ve 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 1 IP) 16 0 0 0 0 0
-Commercial(to 5 I IP) 32 0 0 0 0 0
-Industrial(over 5 I IP) 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:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Scrv/Util-Food Related 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water I?xtractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous I?1)U Count 0 0
Capped [DU Credit 0
T(Yr.U.S 0 0 0 0 1 3 1 3
Current Fixture Value 3 divided by 16= 0.188 Current I: )U 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous 1{ )U
Change 3 divided by 16= 0.188 over (under) S 969.00
Enter EDU Change Here 0.190 ,
`Round MU,: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: Debbie Adamski Date: 2/17/2016
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.
I:ABuilding\Sewer Tally\Scwer'I'allyShcct_51ItL 711115.xlsx