Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2012 -00010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/07/2012
Parcel: 1 S136CD01002
Jurisdiction: Tigard
Site address: 7900 SW PFAFFLE ST
Project: Proforma Graphics Subdivision: 2006 - 016 PARTITION PLAT Lot: 3
Project Description: 1.4 EDU increase for TI.
Contractor: Owner: E &S HOLDINGS LLC
8020 SW PFAFFLE ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
•
Description Date Amount
Specifics: Sewer Connection Fee 02/07/2012 $6,300.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units: 22
Number of Dwelling Units: 1.4
Total $6,300.00
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 co-- of t • ules = • ect questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B � Permittee Signature:
Call 5: <- by 7:00 a.m. for the next available inspec ion dat
This permit card shall be kept in a conspicuous place on the job site until c mole on of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
Ili 2 Tenant Name: Proforma Graphics
SWR # SWR2012 -00010
Site Address: 7900 SW Pfaff le St. PLM # PLM2012 -00019
A Parcel #: 1S136CD01002
Fixture Value Previous Previous Credits Capped Fixture Fixture Ncw New
# value count ca ed #s value count added # added value total #s total values
0 0 0 0 0
Bat:se /Font
4 0 0 0 0 0
Bath: - Tub/Shower 4
- acuzzi /Whirl ool 4
0 0 0 0 0
Car Wash: - Each Stall 6 0 0 0 0 0
- Drive throu h 16 0 0 0 0 0
Cus idor /Water As irator 1
0 0 0 0 0
Dishwasher: - Commercial 4
0 0 0 0 0
Domestic 2
0 0 0 0 0
E Wa s Fountain
1 0 0 0 0 0
1 0 0 0 0 0
E e Wash
Floor Drain /Sink: - 2 inch 2
0 0 1 2 1 2
- inch 5
0 0 0 0 0
- fl 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garba_e Dis osal: t
- Domestic to 3/4 HP 16
0 0 0 0 0
- Commercial to 5 HP 32 0
0 0 0 0
- Industrial over 5 I IP 42
0 0 0 0 0
Ice Machine /Refri•erator Drain 1 0 0 0 0 0
Oil Sc Gas Station 6 0 0 0 0 0
Rec. Vehicle Dum station 16 0 0 0 0 0
Shower: - Gan: er head 1
0 0 0 0 0
- Stall 2 0 0 1 2 1 2
Sink:
- ].av /Bar - Non-Food Related 2
0 0 3 6 3 6
- Bradlc
5 0 0 0 0 0
- Com /Sery /Util - Food Related 3
0 0 0 0 0
Swimmin Pool Filter 1
0 0 0 0 0
6 0 0 0 0 0
Washer - Clothes
Water Extractor
6 0 0 0 0 0
Water Closet - Toilet 6
0 0 2 12 2 12
Urinal
6 0 0 0 0 0
Previous EDU Count
0 0
0
Capped EDU Credit
TOTALS
0 0 0 0 7 22 7 22
Current Fixture Value 22 divided by 16 = 1.4 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 22 divided by 16 = 1.4 over (under) $ 6,300.00
Enter EDU Change Here 1.4
Notes:
Authorized Name /Signature: Dianna I lowse Date: 1/26/2012
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 \Sewer fallySheet- 4500.xls 01 /18/12