Permit CITY OF TIGARD SEWER CONNECTION PERMIT
' 1 COMMUNITY DEVELOPMENT Permit#: SWR2013 00175
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2013
Parcel: 2S 102 BD00100
Jurisdiction: Tigard
Site address: 12520 SW GRANT AVE
Project: St Anthony Subdivision: RTH TIGARDVILLE ADDITION,AMENE Lot: 52
Project Description: 12.06 EDU's for new community center building
Contractor: Owner: ST ANTHONY CATHOLIC CHURCH TIGAR
9905 SW MCKENZIE ST
TIGARD,OR 97223
PHONE: PHONE:
FAX:
•
FEES
• Description Date Amount
Specifics: Sewer Inspection-Commercial 08/28/2013 $45.00
Sewer Connection Fee 08/28/2013 $57,888.00
Type of Use: COM
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 12.06
Total $57,933.00
Required Items and Reports(Conditions)
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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 sus.-•.-• for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. hose rules a : set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OU C by calling 503.232. •: or#_„,0 1.:00 2.2344.
-ued By: #_„,0 �/ / Permi a Signature: .4% /iLismor
Call 503.639.4175 by 7:00 a.m.for the next available inspect• date.
This permit card shall be kept in a conspicuous place on the job site u d completion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
a
Ihil I Tenant Name: St.:\nthony s Church S\VR# 2013-00175
TI Gn R D Site Address: 12520 SW Grant Ave PIA # 2013-00270
Parcel#: 2S102BD00100
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#5 value count added# added value total#s total values
Baptistry/Font 4 0 0 0 0 0
Bath: -'fub/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 1 4 1 4
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 14 28 14 28
-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 HP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 1 1 1 1
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:
-I_av/Bar-Non-Food Related 2 0 0 15 30 15 30
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 3 9 3 9
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 17 102 17 102
Urinal 6 0 0 3 18 3 18
Previous EDU Count 0 0
Capped EDU Credit 0
'fO7Al,S 0 0 0 0 55 193 _ 55 193
Current Fixture Value 193 divided by 16= 12.063 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 193 divided by 16= 12.063 over (under) S 57,888.00
Enter EDU Change Here 12.060
Notes:
Authorized Name/Signature: Debbie Adamski Date: 8/26/2013
Building Division
Note: The property owner shall retain the ORIGIN Al.sewer tally record. I f 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'allyShect_48UU._U7U 113.xlss