Permit A , I
n CITY OF TIGARD [/1 �i� SEWER CONNECTION PERMIT
1 1 11 c • - COMMUNITY DEVELOPMENT Permit #: SWR2013 -00077
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2013
TIGARD Parcel: 2S 113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 105
Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: .13 EDU increase. 6/24/2013: REPRINTED to correct suite address.
Contractor: Owner: PORTLAND SW CENTER LLC
BY FELTON PROPERTIES INC
ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/10/2013 $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. 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 calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 60/ /9— �°,4de 9 --TJp"/
____ . 221 ..______
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
_ COMMUNITY DEVELOPMENT Permit #: SWR2013 00077
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2013
T I �' L7 9 Parcel: 2S113BA00400
Jurisdiction: Tigard
Site address: 7632 SW DURHAM RD 100
Project: Avamere Home and Hospice Subdivision: ROSEWOOD ACRE TRACTS Lot: D
Project Description: .13 EDU increase
Contractor: Owner: PORTLAND SW CENTER LLC
BY FELTON PROPERTIES INC
ATTN: FELTON, MATT
520 SW 6TH AVE, STE 610
PORTLAND, OR 97204
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/10/2013 $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. Thos- - 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 • calling 503. 19: • 1.800.332.2344.
Issue* By: / / Permittee Sig �� r Gam/
Call 503.639.4175 by 7:00 a.m. for the next available in - pection 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 .; Tenant Name: Avamcre 1 -Iome and Hospice SWR # 2013 -00077
T1:■AIiva Site Address: 7632 SW Durham Rd PLM # 2013 -00112
Parcel #: 2S113BA00400
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptiscry/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 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 1-IP) 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 /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
'TOTALS _ 0 0 _ 0 0 1 _ 2 1 2
Current Fixture Value 2 divided by 16 = 0.125 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
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: 04/02/2013
Building Division
r 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 I'allyShcct- 4665.xls 07/01/12