Permit CITY OF TIGARD SEWER CONNECTION PERMIT
:11 COMMUNITY DEVELOPMENT Permit #: SWR2012 -00108
T [ GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2012
Parcel: 2S112AA00400
Jurisdiction: Tigard
Site address: 14280 SW 72ND AVE
Project: Leifs Auto Body Subdivision: MILLMONT PARK Lot: 49
Project Description: Install (1) new ADA lavatory
Contractor: Owner: WALTON CWOR NELSON 13 LLC
BY CTMT - WALTON RE TAX
4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: PHONE:
FAX:
• FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/06/2012 $450.00
Type of Use: COM
Class of Work: ALT
Install Type: Line Tap
Fixture Units:
Number of Dwelling Units: .1
•
•
•
Total $450.00
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 ad. .ted by the Ore. •n Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may or •in a .py of t - •s or direct questions
to OUNC by calling 5'. 232.1987 or 1.800.332.2344.
Issued By: ` # ' . , - 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 proj t.
Approved plans are required on the job site at the time of each inspection. •
INI Accumulative Sewer Tally
•
a , n Tenant Name: Leifs Auto Body SWR # 2012 -00108
TIGARD Site Address: 14280 SW 72nd Ave PLM # 2012 -00156
Parcel #: 2S112AA00400
Fixture Value Previous Previous Credits Capped Fixture Fixture Ncw New
# value count capped #s value count added # added value total #s total values
Baptistry/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 0 0 0
-3inch 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 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:
- Lay/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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 _ 2 _ 1 2
Current Fixture Value 2 divided by 16 = 0.1 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 2 divided by 16 = 0.1 over (under) $ 450.00
Enter EDU Change Here 0.1
Notes:
Authorized Name /Signature: Dianna Howse Date: 6/6/2012
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 \SewerTallySheet- 4500.xls 01/18/12