Permit
W'q CITY ®F TOC7/~R® SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2010-00028
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/02/2010
Parcel: 2S 101 A000900
Jurisdiction: Tigard
Site address: 7128 SW Gonzaga ST
Subdivision: Lot: 0
Project: Spec Space
Project Description: .1 EDU increase
Owner: FEES
BARMASS LLC Description Date Amount
PO BOX 69409
PORTLAND, OR 97239
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $0.00
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 ques UNC by calling 503.246.6699 or 1.800.332.2344.
Issu By: Perm ittee Signature:
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 # 2S101A000900
'Tenant Name. Spec Space ****RGVIST;D**** This SWR# SWR2010-00028
Site Address: 7128 Gonzaga This PLM# 2010-00044
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
Ba tisc /Font 4 0 0 0 0 0
Bath -Tub/Shower 4 0 0 0 0 0
acuzzi/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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
I? a 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 Drn 6 0 0 0 0 0
Garbage Disposal
Domestic to 3/4 1-11 3) 0 0 0 0 0
Commercial to 5 111 3) 0 0 0 0 0
Industrial over 5 1-11 3) 0 0 0 0 0
Ice ivlaehine/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 - Gan (per head 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar/Lavatory 2 0 0 0 0 0
Bradley 5 0 0 0 0 0
Commercial 3 0 0 0 0 0
Service 3 0 0 0 0 0 0 0
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 FDU Count 0 0
Capped I.-DU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16 = 0.1 Current LDU 1 F,DU = S 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous E" DU
Change 2 divided by 16 = 0.1 over (under) S 360.00
Enter EDU Change Here 0.1
Notes: Revised to change previously identified capped fixtures as relocated fixtures.
Authorized Name/Signature: Loraine Sellers/Debbie Adamski Date: 2/5/2010 - 3/2/10
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.
1:\Building\Sewer Tally\Sewef l'allySheet-3600. xls 06/25/08