Permit CITY OF TIGARD SEWER CONNECTION PERMIT
T .
k . COMMUNITY DEVELOPMENT Permit #: SWR2013 00110
T I G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/20/2013
Parcel: 2S101AB01606
_ . Jurisdiction: Tigard
Site address: 7357 SW BEVELAND RD 100
Project: Mission Increase Foundation Subdivision: HERMOSO PARK Lot: 17
Project Description: .13 EDU increase
Contractor: Owner: MIF LLC
5665 SW MEADOWS RD #160
LAKE OSWEGO, OR 97035
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/20/2013 $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. Speci- Codes - id all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not st• ed wi in 1 ,0 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the r - a•l•pted by \ th= Oregon Utility Notification
Center. T • - rues : - set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may •btain co•y of th- rules or direct questions
to OUNC • calling 5J3.23 . 987 •r 1.800.332.2344.
•
Issue. By: l d o, / / 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 project.
Approved plans are required on the job site at the time of each inspection.
�j.
Accumulative Sewer Tally
Nil C 'Tenant Name: Mission Increase Foundation SWR # 2013 -00110
Site Address: 7357 SW Beveland Rd Suite 110 PIM # 2013 -00155
TIGARD
Parcel #: 2S101AB01606
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #5 total values
Baptisery/ 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 1 -IP) 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:
- l.av /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
'1'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 I..DU
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
ote: 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.
1:A Building \Sewer'I'ally \Sewer 1'allvShect- 4665.x15 07/01/12