Permit (53) CITY OF TIGARD SEWER CONNECTION PERMIT
IN 2' COMMUNITY DEVELOPMENT Permit#: SWR2016-00086
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2016
Parcel: 1S 1260000300
Jurisdiction: Tigard
Site address: 9569 SW WASHINGTON SQUARE RD B04
Project: Godiva Subdivision: VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: 3.06 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 / 1/
03 2 2016 $15,606.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 3.06 ,
Total $15,606.00
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 callin . 2.1987 or 1.800.332.2344.
Issued By: G Permittee Signatu 01/901,
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.
Accumulative Sewer Tally
711 Tenant Name: Godiva SWR# 2016-00086
Site.Address: 9569 SW Washington Square Rd PLM# 2016-00141
TIGARD
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
Baptisers/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 0 0 0
Drinking fountain 1 0 0 0 0 0
lye Wash 1 0 0 0 0 0
l'loor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-3 inch 5 0 0 5 25 5 25
-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 IIP) 32 0 0 0 0 0
-Industrial(over 5 IIP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 1 1 1 1
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 2 4 2 4
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 3 9 3 9
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 1 6 1 6
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:DU Count 0 0
Capped I DU Credit 0
TOTALS 0 0 0 0 14 49 14 49
Current Fixture Value 49 divided by 16= 3.063 Current 1?DU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous IDU
Change 49 divided by 16= 3.063 over (under) S 15,606.00
Enter EDU Change Here 3.060 '
"Round 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.
Notes:
Authorized Name/Signature: Debbie,\damski Date: 3/16/2016
Building Division
Note: The property owner shall retain the ORIGIN AI.sewer tally record. 1f 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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