Permit •
C ITY OF TIGARD SEWER CONNECTION PERMIT
• DEVELOPMENT SERVICES PERMIT #: SWR2005 -00054
A4-1'14 DATE 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/24/2005
SITE ADDRESS; 10225 SW HALL BLVD 102 PARCEL: 1S135AA-01901
SUBDIVISION: METZGER ACRE TRACTS ZONING: C - N
BLOCK: LOT: 037 JURISDICTION: TIG
TENANT NAME: TAGLIO HAIR SALON
USA NO: FIXTURE UNITS: 20
CLASS OF WORK: ADD DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.3 EDU increase
Owner: FEES
GERIG, WAYNE L.
10225 SW HALL BLVD #101 Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connectic 2/24/2005 $3,250.00
[SWUSA] Swr Connectic 2/24/2005 $0.00
Phone: 503 244 - 1004 Total $3,250.00
Contractor:
REQUIRED 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 yo to follow rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 0 ough OAR 952 - 001 -0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503) 2' 6 : •.
Issued by: Permittee Signature. , ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th -xt busines• day
Accumulative Sewer Tally , . Parcel # 1S135AA -01901
Tanant Name: Taglio Hair Salon This SWR #2005 -00054
Site Address: 10225 SW Hall Blvd #102 This PLM# 2005 -00068
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 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 1 2 1 2
-3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 0 l ; 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 1 p �
�� 0 0 0 0
- Industrial (over 5 HP) 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
Rec. Vehicle Dump station 16 0 Q °
0 0 0 0
Shower - Gang (per head) 1 -x / 0 0 0 0 0
- Stall 2 0 0 x 0 0 0
Sink Bar /Lavatory 2 .`.=',, :. / ' �� 0 0 '` 0 0 0
- Bradley 5 �' 0 0
- Commercial 3 , 0 t t 0 4.' 12 4 12 •
Service 3 ;s k 1 0i 0
0 0 0
Swimming Pool Filter 1 134 0
�'� 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0
0
Water Closet - Toilet 6 5
0 0 i 6 1 6
Urinal 6 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit ` 0
TOTALS 0 0 0 0 6 20 6 20
Current Fixture Value 20 divided by 16 = 1.3 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 20 divided by 16 = 1.3 over (under) $ 3,250.00
Enter EDU Change Here 1.3
Notes:
7
Si t re: 1 \ / �l
, `�'�
i Lo
Build Date:
g
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 \SewerTallySheet.xls 7/1/04