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Permit R,, SEWER CONNECTION PERMIT .e CITY OF TIGARD 4. ` l: COMMUNITY DEVELOPMENT Permit #: SWR2010 00098 ,.', Date Issued: 07/27/2010 T I G AR D, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 h_y Parcel: 1S135BC01100 Jurisdiction: Tigard Site address: 11131 SW GREENBURG RD Subdivision: Lot: 0 Project: JUMP SKY HIGH Project Description: 4.1 EDU increase. Owner: FEES ROBINSON FAMILY TRUST Description Date Amount BY E LEE & EVELYN L ROBINSON TRS, PO Sewer Connection Fee 07/27/2010 $16,810.00 BOX 91305 PHONE: Contractor: PHONE: FAX: Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: 21 Number of Dwelling Units: 4.1 Total $16,810.00 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, o ' •ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility ification Center. ., e rules . e set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or dir ct questions to OUNC by ..1' g 513.24. 699 or 1.800.332.2344. Is ued By: K ` / / /�G22 /�L" Permittee Signature: ,r 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 # 1S135BC01100 Tenant Name: JUMP SKY HIGH This SWR# SWR2010 - 00098 Site Address: 11131 SW GREENBURG This PLM# PLM2010 - 00242 l :ixturc Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s values Baptisery/Font 4 0 0 0 0 0 Bath - Tub /Shower 4 0 0 1 4 1 4 - 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 2 2 2 2 lave Wash 1 0 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 1 2 2 4 1 2 - 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 IP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 0 0 0 0 - Industrial (over 5 FIP) 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 /Lavatory 2 0 1 2 7 14 6 12 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 1 3 1 3 - 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 0 0 0 0 0 Water Closet - Toilet 6 0 1 6 6 36 5 30 Urinal 6 0 0 2 12 2 12 Previous EDU Count 0 0 Capped EDU Credit 0 1'0'1': V ,S 0 _ 0 3 10 21 75 18 65 Current Fixture Value 65 divided by 16 = 4.1 Current EDU 1 EDU = S 4,100 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 65 divided by 16 = 4.1 over (under) S 16,810.00 Enter EDU Change Here 4.1 Notes: Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 7/23/2010 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 \Scwer Tally \Sewer'1'allyShcct- 3600.xls 06/25/08