Permit 741 CITY OF TIGARD SEWER CONNECTION PERMIT
- • COMMUNITY DEVELOPMENT Permit #: SWR2013 -00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/15/2013
Parcel: 151 36CC00100
Jurisdiction: TIGARD
Site address: 8200 SW PFAFFLE ST
Project: Westside Christian High School Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: 10.63 EDU increase
Contractor: Owner: WESTSIDE CHRISTIAN HIGH SCHOOL
4565 CARMEN DRIVE
LAKE OSWEGO, OR 97035
PHONE: PHONE: 503 - 697 -4711
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/14/2013 $49,588.95
Type of Use: COM
Class of Work: ADD
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 10.63
Total $49,588.95
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. Tho - u es = - 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. 987 0 1.800.332.2344.
Issue. By: ' Permittee Signature: 9 k/
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.
ve Sewer Tally
1 14 I I errant Name: \ \'cstside Christi I li�h Scho S \CSR # 2013 -00103
TIGARI7 Site Address: 8200 SW I'faftle St PLM # 2013 -00121
Parcel #: 1S136CC00100
Fixture Value Previous Previous Credits Capped Fixture Fixture New 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 1 4 1 4
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 2 4 2 4
Drinking Fountain 1 0 0 3 3 3 3
Eye Wash 1 0 0 1 1 1 1
Floor Drain /Sink: - 2 inch 2 0 1 2 12 24 11 22
- 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-lP) 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 2 2 2 2
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 6 12 6 12
Sink:
- 1..av /Bar - Non -Food Related 2 0 3 6 31 62 28 56
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 2 12 2 12
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 3 18 10 60 7 42
Urinal 6 0 2 12 4 24 2 12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 9 38 74 208 65 170
Current Fixture Value 170 divided by 16 = 10.625 Current I'.DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous l?DU
Change 170 divided by 16 = 10.625 over (under) S 49,588.95
Enter EDU Change Here 10.630
Notes:
Authorized Name /Signature: Debbie Adamski Date: 4/29/2013
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 I'allySheet- 4665.xls 07/01/12