Permit (2) CITY OF TIGARD SEWER CONNECTION PERMIT
' ` COMMUNITY DEVELOPMENT Permit #: SWR2012 -00221
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/01/2012
Parcel: 2S 101 AB90000
Jurisdiction: TIGARD
Site address: 12011 SW 70TH AVE
Project: CH Physical Therapy Subdivision: 2012 -009 PARTITION PLAT Lot: 1
Project Description: 1.13 EDU increase
Contractor: Owner: RED ROCK CREEK CONDOMINIUM
OWNERS OF ALL UNITS
00000
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PHONE: PHONE:
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FAX:
FEES
• Description - Date Amount
Specifics: Sewer Connection Fee 11/01/2012 $5,271.45
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.13
Total $5,271.45
Required Items and Reports (Conditions)
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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 Or-.on Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obt• •• copy of the l'es or dir que Ons
to OUNC by ailing 5 32.1987 o 800.332.2344. /
Issued B • �� / Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection • • te.
This permit card shall be kept in a conspicuous place on the job site until co • letion of the project.
Approved plans are required on the job site at the time of each inspection.
is
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Accumulative Sewer Tally
p Tenant Name: CI1 Physical 'l'h SWR # 2012 -00221
TaG Site Address: 12011 SW 70th Ave PI .NI # 2012 -00324
Parcel #: 2S101AB90000
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values ,
�o
Baptistry/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
: Eye 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 1-1P) 16 0 0 0 0 0
- Commercial (to 5 I-IP) 32 0 0 - 0 0 0
- Industrial (over 5 I-1P) • 42 0 0 0 0 0
. Ice Machine /Refrigerator Drain 1 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 1 2 1 2
Sink:
- l.av /Bar - Non -Food Related 2 0 0 2 4 2 4
- Bradley 5 1 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 1 6 1 6
Water Extractor 6, 0 0 0 0 0
Water Closet - Toilet 6 0 0 1 6 1 6
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Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
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TOTALS 0 0 0 0 5 18 5 18
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Current Fixture Value 18 divided by 16 = 1.125 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous F..DU
Change 18 divided by 16 = 1.125 over (under) S 5,271.45
Enter EDU Change Here 1.130
Notes:
Authorized Name /Signature: Debbie Adamski Date: 11/1/2012
Building Division
ote: 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: \Building \Sewer Tally \Scwcr'I'allyShect - 4665.x15 07/01/12