Permit CITY ` ®F TIGARD SEWER CONNECTION PERMIT
;' 0''. COMMUNITY DEVELOPMENT Permit #: SWR2013 -00109
TiGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2013
Parcel: 2S 113AB00300
Jurisdiction: Tigard
Site address: 16037 SW UPPER BOONES FERRY RD 100
Project: Simpson Property Group Subdivision: FANNO CREEK ACRE TRACTS Lot: 38
Project Description: .13 EDU increase
Contractor: Owner: OREGON STATE BAR, THE
16037 SW UPPER BOONES FERRY RD
TIGARD, OR 97224
PHONE: PHONE: 503 - 620 -0222
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/21/2013 $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 cal • . 503:232.1987 or 1.800.332.2344. t I
Issued By: 1 / r � = � . Permittee Signature: / w �, . ` I `
Call 503.639.4175 by 7:00 a.m. for the next available inspection da l
This permit card shall be kept in a conspicuous place on the job site until complete• n of the project.
Approved plans are required on the job site at the time of each inspection.
•
'PI Accumulative Sewer Tally
p 'T enant Name: Simpson Property Group SWR # 2013 -00109
TIGARD Site Address: 16037 SW Upper Booties Ferry Rd Pl.M # 2013 -00154
Parcel #: 2S 113AB00300
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: -'l'ub /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
Eve 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 11P) 42 0 0 0 0 0
lee 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 /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'I'ALS 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: Debbie .\damski Date: 5/20/2013
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.
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