Permit (17) CITY OF TIGARD SEWER CONNECTION PERMIT
`'•! ICOMMUNITY DEVELOPMENT Permit#: SWR2015-00238
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2016
Parcel: 1S136AA01201
Jurisdiction: Tigard
Site address: 6919 SW OAK ST
Project: Oak Street Care Home Subdivision: 2007-031 PARTITION PLAT Lot: 2
Project Description: 2 DU's for new group living facility(5 or fewer residents).
Contractor: Owner: BARE LLC
22275 SW SCHOLLS SHERWOOD RD
SHERWOOD, OR 97140
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Inspection-Residential 03/15/2016 $35.00
Sewer Connection Fee 03/15/2016 $10,200.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 2
Total $10,235.00
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 g 232.1987 or 1.800.332.2344.
6044/14.Aki Issued y: Permittee Signature: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.
11111 Tenant Name: Oak Street Care
Ahomes
Sewer Tally SWR# 2015-00238
Site.\ddress: 6919 SW Oak St PLM# AlS'I'2015-00307
TIGARD
Parcel#: 1S136AA01201
Fixture Value Previous Previous Credits Capped Fixture fixture New New
# value count capped#s value count added# added value total#s total values
Baptisers/bunt 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 Fountain 1 0 0 0 0 0
live 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
-flinch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 IIP) 16 0 0 _ 0 0 0
-Commercial (to 5 I IP) 32 0 0 0 0 0
-Industrial (over 5 HP) 42 0 0 _ 0 0 0
Ice Machine/Refrigerator Drain 1 0 00 0 0
Living Unit 16 0 0 2 32 2 32
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/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 0 0 0
Urinal 6 0 0 0 0 0
Previous I?Dll Count 0 0
Capped EDU Credit 0
TOT,AI,S 0 0 0 0 2 32 2 32
Current Fixture Value 32 divided by 16= 2.000 Current I?DU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous IIDU
Change 32 divided by 16= 2.000 over (under) S 10,200.00
Enter EDU Change Here 2.000
"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: Group living facility calculated at Residential Rate II -1 DU for first 5 bedrooms,1 DU for every two bedrooms over. 8 bedrooms-5=3-2=1.5
Per C\VS we do not need to round-up the fraction,so 1 DU for first 5 bedrooms plus I Dl`for additional three.
Authorized Name/Signature: Debbie.\damski Date: 3/7/2016
Building Division
Note The property owner shall retain the ORIGIN,AI.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.
1:ABuildini;AScwerlath\SwcrlallySheet_5 IIIIi_11711115.xlsx