Permit CITY OF TIGARD SEWER CONNECTION PERMIT
• • COMMUNITY DEVELOPMENT Permit #: SWR2009 -00093
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2009
Parcel: 2S 101 AB01200
Jurisdiction:
Site address: 7275 SW HERMOSO WAY
Subdivision: Lot: 0
Project: KEYWAY OFFICE
Project Description: 1 EDU to connect existing structure to sewer service. In Sewer Reimbursement District #15.
Owner: FEES
FRANK, BRIAN L & Description Date Amount
KRAFVE, KENT B, 7275 SW HERMOSO WAY Sewer Connection Fee 10/29/2009 $3,600.00
TIGARD, OR 97223 Sewer Inspection - Commercial 10/29/2009 $45.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units: 16
Number of Dwelling Units: 1
Total $3,645.00
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. `
Issued By i ` I / ' � Permittee Signature: 7�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 Parcel # 2S101AB01200
Tenant Name: Keyway Office Building This SWR# 2009 - 0093 •
Site Address: 7275 SW Hermoso Way This PI..M# 2009 - 00187 •
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptiscry/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 V 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 .ye Wash 1 0 0 0 0 0
Flour 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 Drn 6 0 0 0 0 0 '
Garbage Disposal
- Domestic (to 3/4 I-IP) 16 0 0 0 0 0
- Commercial (to 5 1 -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
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 - Bar /L.avatory 2 0 0 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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 V 0 0 0 0 0
Water Closet - Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'I'(YI':\I S _ 0 _ 0 0 0 4 16 _ 4 16
Current Fixture Value 16 divided by 16 = 1.0 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 16 divided by 16 = 1.0 over (under) $ 3,600.00
Enter EDU Change Here 1
Notes: SF converted to commercial use, Reimbursement District #15 fee paid.
Authorized Name /Signature: Debbie Adamski Date: . 9/4/2009
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: \ Building \Sewer Tally \Sewer rallySheet- 3600.xls 06/25/08