Permit r `
CITY TIGARD SEWER CONNECTION PERMIT
i DEVELOPMENT SERVICES PERMIT #: SWR2005 - 00229
l �.��I DATE ISSUED: 7/25/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S101 BD - 00105
SITE ADDRESS: 12805 SW 77TH PL ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: 2.3 edu increase.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 2.3
TYPE OF USE: COM . NO. OF BUILDINGS:
INSTALL TYPE: BUSWR • IMPERV SURFACE:
Owner: FEES
BR +GCOLLC
PO BOX 23009 Description Date Amount
TIGARD, OR 97223 [SWUSA] Sewer Connection Fee 7/25/2005 $5,980.00
Total $5,980.00
Phone:
Contractor:
REQUIRE D ITEMS AND REPORTS
•Phone:
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.
10 /
Issued by: Permittee Signature:
J `
Call 503 - 639 -4175 by 7:00 a.m. for an inspection at b siness day.
This permit card shall be kept in a conspicuous place on the job site ntil completion of the pr ject.
Approved plans are required on the job site at the tun of each inspection.
Accumulative Sewer Tally Parcel #S1011 BD ,T 00105 w irtf"i
,Tennt Name Terex,Utilities ,• ° , * ?2,,,1)1, ;2 This SWR #200V),0229e C ' ri ,
Site Address 1,2805,SW77th PI We kl This PLM #2005100324
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
Baptisery/Font 4 ,i 0 0 ,• 0 0 0
Bath - Tub /Shower 4 ,,;` 0 . f n ..,,: 0 0 0 0
- Jacuzzi /Whirlpool 4 '.&Yi,�,.0 "3 0 t 0 0 0 0
Car Wash - Each Stall 6, rgiaiii 0n'.,: , - 0 0 0 0
- Drive through 16 rign• 0.,,,,, 3t1 0 1, 0 0 0
Cuspidor/Water Aspirator 1 r , 7 , . 0 , s ' 0 F ," • 0 0 0
Dishwasher - Commercial 4 I,, . „.,� 0 rm
,,r .: 0 kreglii 0 0 0
- Domestic 2 0 0 f, ” �` 0 0 0
Drinking Fountain 1 }> .X 0 1:45i..'--t"
, 0 Ingq, 0 0 0
Eye Wash 1 ? xx 0 ' 0 " �' 0 0 0
Floor Drain /Sink - 2 inch 2 A5 : ; 0 0 killiZt 2 1 2
- 3 inch 5 ... 0 0 1, 0 0 0
- 4 inch 6
*,,fi 0 0 lag!!--A 0 0 0
- Car Wash Drr 6 w ,V, 0 1 w k 0 i 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0, v 0 0 0
- Commercial (to 5 HP) 32 ' tilitiffil9 0 ,,F,f, 0 67 ,, 0 0 0
Val* ,
Industrial (over 5 HP) 42 ", ,,� 0 u 'i 0 : , 0 0 0
o
Ice Machine /Refrigerator Drain 1 „; 0 0 •, 0 0 0
Oil Sep (Gas Station) 6 1,Pi3 0 0 4, 0 0 0
Rec. Vehicle Dump station 16 �,:,�s
k 0 0 1". 0 0 0 .
Shower - Gang (per head) 1 , i 0 ,1,4 ,_- 0 f � 0 0 0
-Stall 2 0 0 , q , 0 0 0
Sink -Bar /Lavatory 2 i p� 0 %:;:i 0 F 2 . 4 2 4
- Bradley 5 0 t ' '; 0 >.,,x41}' 0 0 0
Commercial 3 j,.. - 0 0 .K,,,
• - Service 3 •0 WOW 0 iSitiM 0 0 0
Swimming Pool Filter 1 Z
Washer - Clothes 6 i `.. ` -= ` 0 S ,.0' 0 , • 0 0 0
x �;`• n
Water Extractor 6 „�` I°
0 i 0 ; 0 0 0
Water Closet - Toilet 6 a,,,, 0 - > 0 74 18 3 18
6 s
. 0 2 12 2 12
Urinal Fy�,.ti��. ,_ 0
Previous EDU Count is 0 0
Capped EDU Credit' 0
TOTALS 0 0 , 0 0 8 36 8 36
Current Fixture Value 36 divided by 16 = 2.3 Current EDU 1 EDU = $ • 2,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 36 divided by 16 = 2.3 over (under) $ 5,980.00
Enter EDU Change Here 2„µ 31.
Notes:
Authorized Name /Signature .. .. ;g' .:`.. i3. : 1;:•• • _. Date TN.;... Q7, at i -_
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i:\Building\Sewer Tally \SewerTallySheet.xls 7/1/05