Permit CITY OF TIGARD SEWER CONNECTION PERMIT
III I COMMUNITY DEVELOPMENT Permit #: SWR2012 -00242
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/27/2012
Parcel: 2S 114AA00100
Jurisdiction: TIGARD
Site address: 9000 SW DURHAM RD
Project: THS - Team Room Rennovation Subdivision: 1993 -078 PARTITION PLAT Lot: 2
Project Description: .13 EDU increase
Contractor: Owner: TIGARD - TUALATIN SCHOOL DISTRICT
6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: PHONE: 503 - 431 -4000
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/27/2012 $606.45
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $606.45
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. T re 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 calling 503.232.1987 503.232.1987 or . 0.332.2344.
Issue y: Permittee Signature: / Call 503.639.4175 by 7:00 a.m. for the next available inspectio 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
N = n Tenant Namc: Tigard HS Girl's Locker Room SWR # 2012 -00242
TIGARD Site Address: 9000 SW Durham Rd PI.M # 2012 -00369
Parcel #: 2S114AA -00100
Fixture Value Previous Previous Credits Capped Fixture Fixture Ncw Ncw
# 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
- 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 I IP) 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 Scp (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 /Serv/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
'l'O'l'ALS _ 0 0 0 0 1 2 1 _ 2
Current Fixture Value 2 divided by 16 = 0.125 Current El)U 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous I?DU
Change 2 divided by 16 = 0.125 over (under) S 606.45
Enter EDU Change Here 0.130
Notes:
Authorized Name /Signature: Shirley Treat Date: 12/20/2012
Building Division
u ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \ Building \Sewer Tally \Sewer"1'allyShcct- 4665.xls 07/01/12