Permit CITY TIGARD SEWER CONNECTION PERMIT
I DEVELOPMENT SERVICES PERMIT #: SWR2004 -00317
Ail DATE ISSUED: 11/1/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 07632 SW DURHAM RD 125 PARCEL: 2S113BA -00400
SUBDIVISION: SW CENTER SDR1999 - 00020 ZONING: I -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: COLUMBIA COMMUNITY BANK
USA NO: FIXTURE UNITS: 21
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1..3 EDU increase
Owner: FEES
OPUS REAL ESTATE OREGON IV LLC
1000 SW BROADWAY Description Date Amount
1130 [SWUSA] Swr Connectic 11/1/2004 $0.00
PORTLAND, OR 97205 [SWUSA] Swr Connectic 11/1/2004 $3,250.00
Phone: 503 916 - 8963
Total $3,250.00
Contractor:
Phone:
Reg #:
Required Inspections
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 obtai ..ies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Iss -d by: 2 TL i' �
Permittee Signature: / / / 1/ i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally Parcel # tad41 i`
{
aa@ ., �i ? 05 ti- 'i '`` Q mg This SW R# -� i Q �i t 11
Y w
it,' ti ®i ` 4' . 41 ) . '7d� � TY ;7 . r6..` This PLM #W i4 e t*� •
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 , t t 0 :.:4,',40•''.= 0 k >. 0 0 0
Bath - Tub /Shower 4 4g:0 0 r 0 t
- Jacuzzi/Whirlpool 4 Wiz , 0 0 AIR, 0 0 0
Car Wash - Each Stall 6 N � 0 0 z `; 0 0 0
Drive through 16 0 IV: 1. o 0 0 0
Cuspidor/Water As irator 1 �� 0 '"
Dishwasher- Commercial 4 ; ,, ,43 � 0 � o .,..v4:44,7: , 0 0 0
- Domestic 2 1 0 .ma 0 , ; l 2 1 2
Drinking Fountain I 5,�0,1 0 ; AS 0 A 0 0 0
Eye Wash 1 0 ttV 0 0 0 0
Floor Drain /Sink - 2 inch 2
�� �,;! r . 0 �dw� ,,
- 3 inch 5 __ > , Z m 0 ., A 42 0 0 0
- 4 inch ,<: p:
- Car Wash Drr 6 oA , „ 0 ' �, 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 ra 0 g ` " _ 0 4 ' ^, ek
: ,. 0 0 0
- Commercial (to 5 HP) 32 u 0 w 0 .; 0 0 0
- Industrial (over 5 HP) 42" '° 0 '' 0 0 0
Ice Machine /Refrigerator Drain 1 ,� F, 0 oat:, 0 0 0 0
Oil Sep (Gas Station) 6 ,�h 0 0:x 0 0 0
Rec. Vehicle Dump station 16 4:4A 0 0 ill 0 0 0
Shower - Gang (per head) 1 0 ... 0 0 0
- Stall 2 a �, ; : ; , fi , 0 0 '' 0 0 0
Sink - Bar /Lavatory 2 `' 0 `°�• 0 :'' itf 4 2 4
- Bradley 5 , . 0 �. 0 -, 0 0 0
- Commercial 3 F 0 0 0 0 0
- Service 3 0 0 ) � « 3 1 3
Swimming Pool Filter 1 4 0 0 r--4 0 0 0
Washer - Clothes 6 0 0 � 0 0 0
Water Extractor 6 0 * 0 e 0 a a 4
,� '
Water Closet - Toilet 6 -' _ x..
0 0 $ � . ' 12 2 12
Urinal 6 0 x 0 A r 0 0 0
Previous EDU Count - l: 0 0
Capped EDU Credit zatilN 0
TOTALS 0 0 0 0 6 21 6 21
Current Fixture Value 21 divided by 16 = 1.3 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 21 divided by 16 = 1.3 over (under) $ 3,250.00
Enter EDU Change Here 4i4 :; ,:i:
Notes:
Si! ature: ._ ? . AI_' 4 ,600 ' Date: BIM
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.
is \Building \Sewer Tally \SewerTallySheet.xls 7/1/04