Permit _ 1 '
- CITY OF TIGARD SEWER CONNECTION PERMIT
, DEVELOPMENT SERVICES PERMIT #: SWR2003 -00368
T O DATE ISSUED: 2/3/04
`-- 13125 SW Hall 13 :I., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; .12�8 �W GRANT ST PARCEL: 2S102CB -00100
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: R -12
BLOCK: LOT: 041 JURISDICTION: TIC
TENANT NAME: CF TIGARD ELEMENTARY
USA NO: FIXTURE UNITS: 681
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 6 EDU increase. Demo'd previous building of 38.1 EDU's, new building will have 42.6 EDU's. New
building of 42.5 minus old building credits of 38.1 = 4.4 EDU's
Owner: FEES
TIGARD - TUALATIN SCHOOL DISTRICT #23
6960 SW SANDBURG RD Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connect 2/3/04 $10,560.00
[SWUSA] Swr Connect 2/3/04 $0.00
Phone:
Total $10,560.00
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" Perm
Issued by: ( 4110 I Permittee Signature: 1)q
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Name:C F 7 Vol Ede""^" 'i ' This SWR# A - ea '56 /
Address: 12 R' CO C^W -
g - JT A.v .t.. This PLM #: 0 v ' - v 0 S F
'
Fixture Value Previous Previous c Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6 .
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4 / y
- Domestic 2
Drinking Fountain 1 . 30
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5 3 J / - 26 3s /2.5--
- 4 inch 6
- Car Wash Drn 6
Garbage Disposal 16
- Domestic (to 3/4 HP) .
- Commercial to 5 HP 32 2 a -
- Industrial (over 5 HP) 42 .
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16 ,
Shower - Gang (Per Head) 1
- Stall 2 �� 1
Sink - Bar /Lavatory 2 2 O 1 10 0 - --
- Bradley 5
- Commercial 3 6, 6 /9C • 1 G.a /06 -
- Service 3
Swimming Pool Filter 1 /-
Washer - Clothes 6 I (0
Water Extractor 6 / gw
Water Closet - Toilet 6 2 T / (a 8 3 I -
Urinal 6 , i 3 7g of
TOTALS
?& 51 a- 744 19
Total fixture values: /9' / divided by 16 = ���. /3 EDU / / � DLQ ' .. .eb iiii ,.. ,,
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# / J PLM# EDU# SWR# • 1 is \dsts\swrtaly.doc / a— lQ Z 0 ,0 � 6_ i(,�, i
y ?- 5 ��u'� = 760 - . t.�u (( ! 47.5 E-rx, 's .
i( r
3g E I: 51 P- it 4- 4-0-N t
? � si Clime ` . - i - re,,&- Go trD.r'
..tx
Accumulative Sewer Tally Parcel # 0. S i �. C wcc) I CCU
Tenant Name:. 1.F -,-r t -C-, bi 0 E-1.-.0 =v1 ,£ .) ; t{ 't This SWR# i�-c , , CO :- L,
Site Address: • -� e ,,i,j GZ -1-r %1 This PLM# Doc > =, • CC 60
_________12,__L5_5 _
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 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 1 4 1 4 1 4 1 4
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 30 30 30 30 3 3 3 3
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 15 30 15 30 0 0 0
- 3 inch 5 14 70 14 70 30 150 30 150
- 4 inch 6 7 42 7 42 0 0 0
- Car Wash Drn 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 2 64 2 64
- Industrial (over 5 HP) 48 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 64 128 64 128 20 40 20 40
- Bradley 5 0 0 0 0 0
- Commercial 3 1 3 1 3 62 186 62 186
- Service 3 5 15 5 15 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 1 6 1 6 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 33 198 33 198 31 186 31 186
Urinal 6 14 84 14 84 7 42 7 42
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 185 610 185 610 157 _ 681 157 681
Current Fixture Value 681 divided by 16 = 42.6 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 610 divided by 16 = 38.1 Previous EDU
Change 71 divided by 16 = 4.4 over (under) $ 10,560.00
Enter EDU Change Here '4.4
Notes: ..j
7 1/
1 , Signature:, , /.:'d ; . _ V; W �y Date: - - 2, -- -/
L 7110"r' = u1Id1ng 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 submit City of Tigard Building Division to redeem credits towards future system development charges.
is \Building \Sewer Tally \SewerTallySheet xls 11/19/03
7/28/2004
Case Activity Listing 12:08:341 M
TIDEMARK Case #: SWR2003 -00368
COMPUTER SYSTEMS, INC
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SWRC003 Application received 9/25/2003 None DONE BB 9/25/2003
BLD
SWRC008 Permit Created 9/25/2003 None DONE BB 9/25/2003
BLD
SWRCO25 USA Sewer Card 10/23/2003 None DONE DEB 10/23/2003
Processed DEB
SWRCO32 Post - review 10/23/2003 None DONE DEB 10/23/2003
completed DEB
SWRC070 Ready to issue 10/23/2003 None DONE DEB 10/23/2003 Case fmal after issuance.
DEB
SWRC080 (F) Issue permit 2/3/2004 None DONE BB 2/3/2004 Payment authorized by Brian
BLD Radabaugh.
SWRC720 Case Finaled 2/3/2004 None DONE BB 2/3/2004
BLD
SWRC083 (F) Reprint permit 7/28/2004 None DONE JMT 7/28/2004 Per Engineering, changed address
JMT from 12850 (parcel retired). Sending
a copy of this reprint to COT Finance
Dept and an e-mail to Clean Water
Svcs for billing purposes.
Page 1 of 1 CaseActivity..rpt