Permit ph CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2011 -00134
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 09(15/2011
Parcel: 151260000300
Jurisdiction: Tigard
Site address: 9597 SW WASHINGTON SQUARE RD B13
Project: Lush Subdivision: Lot:
Project Description: 3 EDU increase
Contractor: Owner: PPR WASHINGTON SQUARE LLC
BY THOMSON PROPERTY TAX SERVICES
ATTN HILARY RAYMOND
CARLSBAD, CA 92008
PHONE PHONE.
FAX.
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/15/2011 $1,350.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units: 2
Number of Dwelling Units: .3
Total $1,350 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 -0090 You may obtain a copy of the rules or direct questions
to OUNC by calling 503 232.1987 or 1 800 332 2344.
Issued By: Permittee Signature:
Ito .�
Call 503.: • 5 by 7:00 a.m. for the next available inspection date.
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.
M Accumulative Sewer Tally
" l'enant Name. Lush SWR # SWR2011 -00134
a
Site Address. 9597 SW Washington Square Rd PI ,M # PLM2011 -00285
N Parcel #: 1S1260000300
Fixture Value Previous Previous Credits Capped Fixture lixture New New
# value count capped #s value count added # added value total #s total values
Baptisery/ 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 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
[ye Wash 1 0 0 0 0 0
floor Dram /Sink. - 2 inch 2 0 0 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 I -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.
- ],av /Bar - Non -Food Related 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Sery /Utd - Food Related 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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous [DU Count 0 0
Capped EDU Credit 0
1`O'1'ALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16 = 0.3 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 4 divided by 16 = 0.3 over (under) $ 1,350 00
Enter EDU Change Here 0.3
Notes
Authorized Name/Signature: Dianna Howse Date: 9/9/2011
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 \Sewcrl'allySheet -450O \Is 07/01/11