Permit q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00359
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12(02!2011
Parcel: 2S101AB00100
Jurisdiction: TIGARD
Site address: 12005 SW 70TH AVE
Project: Acupuncture Clinic Subdivision: Lot:
Project Description: 12/2/11, this permit replaces all fixture work under PLM2011- 00273. Sewer fixture fees remain paid under
PLM2011- 00273.
Contractor: WOLCOTT PLUMBING Owner: RED ROCK BUSINESS ASSOCIATES LLC
1075 W HISTORIC COLUMBIA RIVER HWY 23077 SW NEWLAND RD
TROUTDALE, OR 97060 WILSONVILLE, OR 97070
PHONE: 503 - 667 -1781 PHONE:
FAX: 503 - 667 -9891
FEES
Quantity Description Date Amount
•
1 ea Clothes Washer 12/02/2011 $25.02
Specifics: 1 ea Floor Drain /Floor Sink/Hub 12/02/2011 $25.02
2 ea Sink 12/02/2011 $50.04
Type of Use: COM 3 ea Laundry Tray 12/02/2011 $75.06
Class of Work: ALT 1 ea Tub /Shower /Shower Pan 12/02/2011 $12.51
Type of Const: 3 ea Water Closet 12/02/2011 $75.06
Occupancy Grp: 1 ea Water Heater 12/02/2011 $37.52
Stories: 1 12% State Surcharge - 12/02/2011 $36.03
Plumbing
Total $336.26
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ification = ter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or d ect questions to O C • •.!ling 503.232.1987 or 1.800.332.2344.
Iss ed By: - 1 / Permittee Signature: v
„71
Call 503.639.4175 by 7:00 a.m. for the next available inspection da e.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application, ii
Building Fixtures r Et ,,,,,,,,,,,, 11
. R ; ,. — ;, i , a, k: FOR OFFICE USE ONLY
Cl Of Tigard t'i Received � A �/ ,�y,�?
`� r,. -- ( °. G$ „ Date /By: Y� R // I Permit No. 4/7 // et 35 f
- q 13125 SW Hall Blvd., Tigard, OR 97223 1,.),7_,,, 1 Plan Review
II
Phone: 503.718.2439 Fax: 503.598.1960 Inn Date /By. Other Permit No.:
TIGARD Inspection Line: 503.639 � €�
Internet. www.tigard - gov x � 4 . Date Read /By, tuns. El See Page 2 for
< . . - . .,.. "..,, Sri i s� 1:s
.. i Ill 19 ic; 1_ P�Et Supplemental _,; : ; "> ...a_ .... " - " "._ .. .., ,.: , "x��.:.. - ...:.�,. < :_ s fFed /M „ mental ln
I ._„
ou ethod Su a[ion
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® New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. ] Total
❑ Addition /alteration /replacement ❑ Other: New 1 dwellings (includes 100 ft for each utility connection)
s z,-
. ” -" k . + Y :OF GO SFR 1
_ ?:= ATT;GOR NSTTti1CT10N'" "'f a Q ; ,: o T ( ) bath 312.70
_
t ,
❑ I- and 2- family dwelling ® Commercial /industrial SFR (2) bath 437 78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath /kitchen 25 02
❑ Master builder ❑ Other:
Fire sprinkler 2
M^.. ;�, x.;' „, r �; >M�. "... ��,
e spr r ( s Page
.a
= :,:dg, :,' , :INI OR1YJAT.ION AND5LO .CATIO ": -"F°s '._; , ' :; ` Site utilities:
Job site address/gyp,j,W70 H AVE Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: TIGARD, OR 97223 Footing drain (no linear ft.. ) Page 2
Suite /bldg. /apt. no.: Project name: ftseexi Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.. _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
r,: ppir,,, , =b: c a, 6 :- ,4 r Backwater valve
p�i :;.`� ,.s "s(�° "- �r,.;� 1251
,: . : DESCRiP PI®N : OF = :WORIC.< ;. ?:` ;,r..
� ,,..�'':�, ,_. .,v�� .. , ., ..; _.,r.,,;,•�.;•., . ;r;_;.<:,_• " _ _. ,::. � �?' �:a:::;,,�_; ' � ”
� ;; � ;k.%:: ` Clothes washer 1 25.02 2
_ 5 1) A., 25.02
11-1‘// T 'eta net 5 6- � f% �r l t-fi �O 44 ' �. 25.02
p X011 � / 7�3j• 5-it4A/L �, r e5 41,14, xi Drinking fountain 25.02
Alitr> LtIJDEJL At/ ae/ /- 002-7 Ejectors /sump 25.02
i :'>'' '_',. t. F r ” .:" Expansion tank
k_. . .
0 ., P "ROl'FRTY N E , c c .. :;' /'- ?,' :.- Y.' r „ '`TEN ,- . C..W. , P 12 S ]
-,_a .. ..��.. - _, .,.. , l''': .. - � r� ". ° ,�., . "._ `= ;mot,
Name:
Fixture /sewer cap 25,02
Address: Floor drain /floor sink/hub i 25.02 gm
Garbage disposal 25.02 •
City /State /Z1 P: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
�:.y °, i:t4Y "" ,,:•3::" ^a3�;a, g,�- � - x , :; �,yra"v'; 9;?.,rri��
.k _° ®' f.piti 74: P '' x x' ; Interceptor/grease tra
a,,.; e:'.�`.,�,.. �� `cas�.;; _ - �`FCON�'FACT, °�'', "'� trap 25.02
Business name: WOLCOTT PLUMBING Medical gas (value. $. Page 2
Primer 12.51
Contact name: CLIFF BOWMAN —
Roof drain (commercial) 12 51
Address: 1075 W HISTORIC COLUMBIA RIVER HWY
Sink/basin /lavatory A-4 i 3 —L, 5 25.02 4267/
City /State /ZIP: TROUTDALE, OR 97060 Solar , :otable water) 62.54
Phone: (503) 667 - 1781 X381 Fax: : (503) 667 - 9891 Tu. shower hower pan 1 12.51 12.51
E - mail: cbowman @wolcottplumbing.com Urinal 25.02
A: ,.1,. s :,, mow: ::,. Water closet 3 25.02 75.06
Water heater 1 37.52 37 52
Business name: WOLCOTT PLUMBING
Water Pm i P DWV 56.29
Address: 1075 W HISTORIC COLUMBIA RIVER HWY Other 25.02
City /State /ZIP: TROUTDALE, OR 97060 Subtotal 5 co,2 3
Phone: (503) 667 - 1781 Fax: (503) 667 - 9891 Minimum permit fee: $72.50 X
CCB Lie.: 112220 Plumbing Lie. no.: 26 - 824PB
Plan review (25% of permit fee)
State surcharge (12% of permit fee) a3'(e.•Q3
Authorized signature: , TOTAL PERMIT FEE `tt`4
• .Plp
Print name: CLIFF BOWMA -' Date: 12/2/11 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
°Fee methodology set by Tri- County Building Industry Service Board
rvBuddingvPermitsvPLMU- PermitApp doc 10/01/09 440- 4616T(i0/02/COM /WEB)
Plum bing_Permit Applicati DI CEIVED
Building Fixtures rot: 0fflc:E 1)51'• ONLY
City of Tigard APR 10 2012 Received y ,1 1'rrmitNa.;
— a 13125 SW Ball Blvd., Tigard, OR 97223 Da1e/13Y I 1 1)- v �LMO20/Z—.002
tl Phone: 503.718.2439 Fax: 503.
Plan Review Inspection Line: 503.639.4175 �F TIGA pate /B
Other Permit No,;
TtGAatu BUILDING DIVISION bateReady /sy, / see Puga2
Internet: www,tigard- or.gov
No1;Gnd/MetlWd: Sunnlcmental information
tU'd;:',Ii ( r �,(,'I,t� i' , ' , � QC. •�.c :l,L.l Irl!i:v:� �a.,'r .J:'EI1lJ, � ltd 1 �i:'I . I'rr ',, li ?I ,' ,�,r. -
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,�.,.,,IrI�„ „111'.;.1_. „f,I {11;1 ?idG {I�III' � 1ir.{ , 5! I, "1, '. i l: I. r 'n:' (� {•.I „ L, . „ I, .. a..” p '!II. ' "m '! tl'"i�. -.I �r, r.l I!ill
, 1 , ,.i� . { fIi'l)41tr, rrl�tt III Idrlr�.h Ia �r.� �(II�I!11h.'.!tI!. �.�1 -r ILt.�..I1� .L.:.r.�n�..l�IiA !IF.LI:;,n! � •V,Ir- .r,r!a viii? ?hh.T1� . r, i �9,�1I• II,I'.�Tt� : � �i!1:;!I'.:.:;:•u!rl�; n!..1tI1vI:;G ��:F.ii;i %�.;l:,i:
New construction ❑ Demolition Fur special information use checklist
Description Qty. I Ea. I — Total
❑ Addition/alteration/replacement ❑
Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
,.l 6 _ ,, ,� , �, � l y ,e,�n �.. i � fllnur 'll . , !rt. "B,, •I,1 .,, t ^ �- ,
:Ilia lt! I i II,4i ! I! j ;l y: t ' ' g %ry {�mpp�{ /{��{,4 sn �IT�t i i , !,� t1;I1 111:; II!NI;II d1IIi4 SFR bath
,n�, I'... l,�eil +lii,� %�ii.,;ii I {,1' 11111: 1' iiM�, T��RIflIi1T161UlVII1liAfill !.?Ktllt��7t' R, 1MrcRIP .'lcSti6f;l+t: Ill!i;t; ?I!•jiI i ;!.•.V � I (
r 1r'. ii a. I':(U,y di lii:i:tlPml'
❑ 1- and 2- family dwelling �ommurcial/industrial SFR (2) bath M '137,78
SFR (3) bath 500.32
❑ Accessory building 0 Multi - family -
❑ Master builder Each additional bath/kitchen IIIIIII 25.02
❑ other: �
�,,;iii;i . I l ei ' ti i .. , ,r r�.�µ Fire Fire sprinkler ( sq. t1,)
�q,.
�'1 . � !! I i , „ ih E ��� �rN �,N y � i � pf�� i , I {
a, lt„I:III. �,li, � ii rIr II:I n, hall li,� . �I,' '.��j11�n rSh!Trt ^t!flf'.I�rT f '°�e�'r,,,,lT'�f MiM`IW`,�:.1A r 11 I , 1I I t { 1 Ij Site Iltitilleti: _
Job site address: r 2,,,,,z,— s c$ Aid Catch basin or area drain ] 8.7b
City/State/ZIP: t ��„�> 4
Drywall, leach line, or trench drain 18.76
Footing drain (no. linear ft.: __) Page 2
Suite/bldgJapt no.: I Project name: /9ezeun,e7-1(46 CGlN/ Manuthctured home utilities 50.03
Cross street/directions to job site: Manholes M 18.76 =
_
Rain drain connector 18.76
Sanitary sower (no. linear ft.: _,) - Page 2
Storm sewer (no. linear ft.: „) 111111111 Page 2
Water service (n0, linear ft.: ___J Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backllow preventer 31.27
I'I' iIlil (,;" ; I ,r l ,,ii .' 4 }I i'J l .: , i.ii∎ 1 1 : 1;i, , i l t; '!R.l ! i 10, � l ,, l , , „. ., Backwater valve 12
;i'; ,
i {Ii a,111Ii1? L (,, , , ,,!,., S. I 1 I; I i)(l ! r:!i i t , : S I! ,.(. ,, , '.I >I : ; ! . ;, ,,,, ' ;;: ,.;;;
:l! ISI ihl.11t� ,t:,:. �`Il1.�i.d;r ,(`i1'r,ljj. , ,,! ,e,: lis;d. I 1 I ti,' =
` f (. I. �,..,.., ,L1 a...,.1�,,.,�.:., Clothes washer 25.02
f'—te.r�.�+,ftCNtG Cf~,NrG Dishwasher — = 25.02
dd,T� Drinking fountain 25.02
/ f�+D {D t kj � e Y11 zed' -au> Ejeotors/sump 2102
11i ;f jI9 �i l, l (��q p L,�1�A1! �1 ►�(p� in1 . ., . I rt' � { I: � � 1
it ?II t z 4' 1 1151! 0 SlIS. i . QIP,{!,11 giIfi11[SifYlfl? ?!! 1 l'AIl {I i '','.''..11i1,1111 I (' nj I I t rr gfil X11.4. �?l.i:j!ii! ion tank: _ 12.51
�
la 1.3, % r Ir {...III 1' fiT. ij�L! Ii!. i �l�R,! I” ll�ll :i�!•!,L,,i;tiil..:ai!��i�L 1 Expansion
Name: Fixture/sewer cap 25,02
Floor drain/Soor sink/hub gm 25.02
Address : --
Garbage disposal 25.02
City /State/ZIP:
Hose bib 25.02
Phone: ( ) Fax: ( ) ice maker 12.51
:'�i i' !fAIi +7`ii'��i `ii',po 8
"''dja: .: l=1 �:'d' I;'1 ;11.1,1) .1 �.� �.� .i�.:, Intcr
!;,d:..� ; t,: ,. :,• •I i� h ; �i h?Ii..i.,.! :1,,, ;�' J �.,{ CcpWr /grease trill) 25.02
, ...,!tN!6-i;.i:il�r�(.r,ISll ht! �I%{ E, P. I! I�A!. Ttr�Riii���lll�IEi. li�l��ii�ii��) I +Ili;i;l' {I�•�I ��;1Ad!E •rt`'r'!'�A`Iln;r`ihTPllL�i'! i;Il �
Business name: Medical gas (value: S ) MEI Page 2
name: Primer �
Contact ea
e L i , 0. 2
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory — 25.02 Nil'
City /State/Zip: Solar units (potable water) 62.54
Phone: ('B)) to6 Z.,% 1 8l y Tub /shower /shower pan MBE
E -mail: Urinal �� �
: x:01 ti.:T G i .^,.a �.7;, n one .Iw/}.rrs..: .�fr r . _ . Water closet 25.02
' ai5 I ! r !h• � f !! ,1� , r N 1� ti .! 1 -v
l! I 4 I Ay ,1'1 It f•,i I % {;i {.;1Iii!1�( "''(fi6,.4i i'tllli:rj!'�; . I;!!
�:! �if�Itl lrl71li1` II1t: �{• r41�kVI�lh� •I li lift? 7>„VR'•ft14R:11:�11i'ii!III.:1l rcilr Ali; �i{ 1: 1iF'{ I: I: d¢ 1�yi!Frll�.11;�ilHilil,•�2,�;n; rit�i
Water heater 37,5:
Business name: O LZbT•T 1 .ari di 4 CA Water piping/DWV 56.29
Address: / —z '5 g7 •Si�+e etsm.,.i 4 /i j( A. Other; = 25.02
City/Stale/ZIP: - 7,V,,,,, , , ) , 04 toe --)Tiot. __Subtotal
EMIEMIERIMMIll Fax: (54) (p.'? ..T e t I Minimum permit fee: $72.50
CCB Lie.: //2220 Plumbing Lie,. no.: 24 -824 j ;
Plan review (25% of permit fee) —
State surcharge (12% of permit fee) I. 0
Authorized signature: V / TOTAL PERMIT FEE l
Print name: ( e /, . -00 9 4 J Date: 4/ At , •L This permit application expires if permit is not a6taicwd witplu 180 day
after it has been accepted as complete. A A'
"Fee methodology set by in BuildinU Industry Service Bad,
l:1 Bui1dIog \permits1PLMU•PcnnitApp.dac 10/01109 440 -4616T(10 /021COM /WEB) 671
Z0 /t0 39tid ONION 11001OM 1686L99E0S Zb:Et Z t. - -'
Pilutnlbin Per mit Application •- City of Tigard
Page 2 - Supplemental Information 7t wit a ° 11 - a (3 5 1
RECEIVED
Fee Schedule: Residential Fire Sly 1 ression S stems:
,,-. " ":.11 �.,, 4 - .4.5.,2, IP I .c r y i'1,17; 1, � , , T. . ;14 TT; •., � , ,, .. a ,t •'' ,r
!' , � .•.{ • fL ,IlIGI, r � � ir( h ��. � .rl ,1. 7 1 ��1 . �l �:�,rrdr in ;,ins: ,f+•� :iin',j+,9 . ,�•, •..7,_ „ . +P. 0 - ,n•
Sailxl� l ,; 1;''I r• , 1 1, 1. :r: ,ll I ,� pp,+I + � rr I I �!�„1 - P1 1 : '�,� { � .I': , .q01 �+ ,1; 1 , r I4 r, lea 1
lei ,i u,,.41, r .,l, I l l l i . . ,J. . . ? fl,,;i r., Pn!;ai !Rlrl lr.,rCf,.. .u! ff.. ,: ,snT.1P!i'+!;. ,Illy Iiiii ii _a,L�,i�ll, i�llet�ne,'? „i. d,:d,.n, ..,..
Footing drain - 1" 100' 50.03 0 to 2,000 $121.90
-
Footing drain - each additional 100' 37.52 2.001 to 3,600 $169.69 N 1,11701
3,601 to 7,200 $233.2;1 BUILD , - g $ N
Sewer • 1st 100' T 62.54 7,201 and rester $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas S stems:
Water Service - each additional 100' 37.52 W • r ,�.. a'r • H f, ; r �, �rif; •' ;;' I at+ •ar,;Ili : ;r :5r rd
Storm & Drain I st 100' 62.54 _ 6. r 1 7 bl I I IR ! i i :
Ruin Drat 00' 'altx n� I, �;,.••,. , � , IOQ�iiI + f „ 'I -11( i.,! II
$1.00 to $5.000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
; r t additional $100,00 or fraction thereof, to
;Il� .1 �(a1'�, 1 1 I;L car ad
I?�i��i;�l��Il�,��li� +�:f �(� fry" Ar! ll; ii!' I; f;:: i. e�0ltr !' and includina$10.000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
whioh no fee is specifically indicated 90.00/hr each additional $100.00 or traction thereof to
(minimum charge -1 /2 hour) and including $25.000.00.
Inspections outside of normal business 90.00/hr . $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 toe
hours (minimum charge - 2 hours) each additional $100.00 or traction thereof, to
Reinbpection Fees 90.00/hr and including $50,000.00,
Additional plan review for revisions 90.00 /hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge - 1/2 hour)
each additional $100.00 or traction thereof
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
iii : 'i1.. i i:li :i i.l.ii :'i ., + 4 .�, . �:ir:.r r'1': :rl:' :IU .:Ylr'..'1 "� - r.li-�' .:�I.i.f•'i
,1„ 'cQUAUtst r =tmY• ix ur!lTypei "I;;,,',S ;li)' ;1(ll ► 1P .'
� ,,,r, {t;...nr -„ "i�ll'l�.�i�►raii��!f'�� ��'//��>lal�ll��.a�aril`ir�,,
� Af
�t:i.T. r6
e fell
�. for any following.
; � �'. Plan review is r • required of th
iNNar r�Po'iiincd�:... � . , i ,.... .. .•�I "::" . ; !:�Fl.
P an t.y Y S•
9aimtistry/Font Please check all that apply.
B ath - Tub /Shower 0 Any new commercial building with water service 2" and
lacttcci/Whirlpool - greater, except systems desired and stamped by licensed
Cur Wash - Each Stall engineer
•Drive fhru ❑ New exterior plumbing site utilities for any complex structure
Cuspidor /Water Aspirator as defined in OAR918. 780.0040.
Dishwasher - Commercial ❑ Medical gas and vacuum systems for health care ftwilities.
Domestic _ El My multipurpose tire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918 -780 -0040.
Eve Wash
Floor Drain/sink - 2" Submit 2 sets of plans with any of the above.
3" 7 i j150 1 ; 0,,,i P ' i is : + i ,t ni r ! n, i i r,, wti m - m •ft.;,; , r• y � 1.. ,.. a O ; ••�,Y , . • . i ,, : I r l i!;: +t
- 4"
�i�; I,:,: nULI�( �! r: �Y; I 1 (�� llli Pt� t~iitQllf ii� ;�,R.liic : �# 1 h' �? ��'' � ; i; V .ar:z���.i:l�•;r�,r�•�:.,,.v
Cur WasIm Drain
Garbage - Domebtivamon - food ❑ isometric or riser diagram is required for new buildings
Disposal - Domestic -food related T that meet the qualifications above.
- Commercial -food related
- hidustrial -food related
Ice Mach, /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station n ,
Shower -Gang
-Stall -
Sink/Lav -Non-food related 1�� - --..... 1 r -
- Bradley ---
- Commercial -food related
- Service
Swimmin Pool Filter *Note: if the fixture work under this permit results in an
Washer - Clothes
Water Extractor increase of sewer EDUs, a sewer permit will be issued and
water closet - Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: P _ .
http: / /www.tigrard- or.gov /city hall / departments /cd/docs/PLMF- PermitApedoc
E0 /Z0 39tid 9NIHWII1d 110010M T686L99E05 8E:90 ZTOZ /TT /120
Accumulative Sewer Tally
74 ---u
_ "T enant Name: Acupunture Clinic SWR # 2011 -00128
TIGARD Site Address: 12005 SW 70th Ave PLM # 2011 -00273
Parcel #: 2S101AB 00100
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptiscry/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: - I ?ach 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
I ?ye Wash 1 0 0 0 0 0
Floor Drain /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 HP) 16 0 0 0 0 0
- Commercial (to 5 I IP) 32 0 0 0 0 0
- Industrial (over 5 11P) 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 1 2 1 2
Sink:
- l,av /Bar - Non -Food Related 2 0 0 8 16 8 16
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 3 18 3 18
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 14 44 14 44
Current Fixture Value 44 divided by 16 = 2.8 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 44 divided by 16 = 2.8 over (under) S 12,600.00
Enter EDU Change Here 2.8
Notes: No demo credits at this time. 4/11/12: Added (3) non -food related sinks to PLM2011 -00359 for Wolcott Plumbing; quantity changed from (5)
to (8) non -food related sinks. PLM2011 -00359 is a continuation of PLM2011- 00273. 1 {DU's changed from 2.4 to 2.8 -- difference of S1,800.00.
Authorized Name /Signature: Debbie Adamski / Brandon Taggart (4/11/12) Date: 8/25/2011 , 4/11/2012
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 \Scwer'I'allyShect- 4500.sls 07/01 /11