Permit Mg CITY OF TIGARD SEWER CONNECTION PERMIT
P COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00061
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/9/2007
PARCEL: 2S113AD-01800
SITE ADDRESS: 16650 SW 72ND AVE B12 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: 011 JURISDICTION: TIG
PROJECT: JOHNSTONE SUPPLY
Project Description: .9 EDU increase. 4/16/07, REVISED, ADDING .2 FOR A TOTAL OF 1.1 EDU.
TENANT NAME: JOHNSTONE SUPPLY
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.1
TYPE OF USE: CMS NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI Description Date Amount
PORTLAND, OR 97224
[SWUSA] Sewer Connection Fee 3/9/2007 $2,430.00
[SWUSA] Sewer Connection Fee 4/16/2007 $540.00
Phone:
Total $2,970.00
Contractor:
REQUIRED ITEMS AND REPORTS
Contact #:
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the
date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer
laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given.
If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon
law requires you to follow 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 copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu b ✓ 4 41, Permittee Sign.ture: le _
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 # 2S113AD -01800
Tenant Name: Johnstone Supply ** *REVISED * * ** This SWR# 2007 -00061
Site Address: 16650 SW 72nd Ave This PLMI/ 2007 -00100
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
N value capped off value added added total total
count off # s count # value N s values
Baptisery /Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacu77i /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
- 3inch 5 0 1 5 1 5 0 0
- 4inch 6 0 0 0 0 0
- Car Wash Dm 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 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 3 6 0 -3 -6
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 1 3 0 -1 -3
- Service 3 0 0 1 3 1 3
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 0 0 0 0
U 6 0 0 4 24 4 24
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 5 14 6 32 1 18
Current Fixture Value 18 divided by 16 = 1.1 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 18 divided by 16 = 1.1 over (under) $ 2,430.00
Enter EDU Change Here 0.9
Notes: ** *REVISED 4/16/07, ADDED (1) MOP SINK * **
Authorized Name /Signature: Debbie Adamski Date: 3/9/2007
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 \Forms \SewerTallySheet.xls 02/02/07