Permit CITY OF TIGARD ) SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT 'S /.9-- Permit#: SWR2012-00052
T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/16/2012
Parcel: 1 S136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 160
Project: Shell Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: .5 EDU increase. 4/26/12,reprinted to correct tenant name from Tao Nail to Benitoite Nail.5/10/12,reprinted to
correct project name to Shell.
Contractor: Owner: AMERICAN INDUSTRIES INC
1750 NW NAITO PARKWAY
PORTLAND, OR 97209
PHONE: PHONE: 503-478-6603
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/16/2012 $2,250.00
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units: 8
Number of Dwelling Units: .5
Total $2,250.00
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 copy of the rules or direct questions
to OUNC by call' .232.1987 or 1.800.332.2344.
Issued B Permittee Signature: Lr (e `�_
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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.
CITY OF TIGARD s' , , ; SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2012 -00052
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 ® AIIII Date Issued: 03/16/2012
Parcel: 1 S 136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH ST 160
Project: Benitoite Nail Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: .5 EDU increase. 4/26/12, reprinted to correct tenant name from Tao Nail to Benitoite Nail.
Contractor: Owner: AMERICAN INDUSTRIES INC
1750 NW NAITO PARKWAY
PORTLAND, OR 97209
PHONE: PHONE: 503 -478 -6603
FAX:
FEES
Description Date Amount
• Specifics: Sewer Connection Fee 03/16/2012 $2,250.00
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units: 8
Number of Dwelling Units: .5
• Total $2,250.00
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 copy of the rules or direct questions
to OUNC by calf 3.232.1987 or 1.800.332.2344.
Issued By: 61_14.... C -d��/ Permittee Signature: - - =
G.1 ! U f/Q�40
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
•
CITY OF TIGARD SEWER CONNECTION PERMIT
III 4
Q • COMMUNITY DEVELOPMENT Permit #: SWR2012 -00052
Date Issued: 03/16/2012
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1S 136DCO2504
Jurisdiction: Tigard
Site address: 7275 SW DARTMOUTH .ST 160
Project: Tao Nails Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: .5 EDU increase.
Contractor: Owner: AMERICAN INDUSTRIES INC
1750 NW NAITO PARKWAY
PORTLAND, OR 97209
PHONE: PHONE: 503 -478 -6603
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/16/2012 $2,250.00
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units: 8
Number of Dwelling Units: .5
•
Total. $2,250.00
Required Items and Reports (Conditions)
4
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. S. - -Ity Codes and a other ap• 'cable
law. All work will be done in accordance with approved plans. This permit will expire if work is not s : withi 180 day of issua e, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules - ....-d by / e '.ireg' n Utili otification
-
Center. T. . -. - e set fort in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtai .. ./th- - or • ect questions
to OUN .y call', g 503.23 . •8 •r 1.; e. 332.2344.
Issu• • By:
- i !/ �- Permittee Signature: . -
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
Accumulative Sewer Tally •
4
_ . 'Tenant Name: TAO NAILS SWR # SWR2012 -00052
TIGARD Site Address: 7275 SW DARTMOUTH ST SUITE 160 PLM # PLM2012 -00059
Parcel #: 1S136DCO2504
Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw
# value count capped #5 value count added # added value total #s total 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
1:?ye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 I-IP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 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 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:
- Lav /Bar - Non -Food Related 2 • • 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Com /Scrv/Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'1'OTAI.S _ 0 0 0 0 2 8 2 8
Current Fixture Value 8 divided by 16 = 0.5 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 8 divided by 16 = 0.5 over (under) S 2,250.00
Enter EDU Change Here 0.5
Notes:
Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 3/15/2012
Building Division
IN ote: The property owner shall retain the ORIGINAL sewer tally record. I f 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 I'allyShect- 4500.xls 01/18/12