Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2013-00178
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/04/2013
Parcel: 25101 BCO2401
Jurisdiction: Tigard
Site address: 12650 SW HALL BLVD
Project: Snyder Roofing Subdivision: TIGARDIA TERRACE Lot: 3
Project Description: 1.56 EDU increase.
Contractor: Owner: JFK PROPERTIES OREGON LLC
12650 SW HALL BLVD
TIGARD,OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/04/2013 $7,488.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units:
Total $7,488.00
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:
Call � 5 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.
Accumulative Sewer Tally
II a
C Tenant Name: SNl'DISR ROOFING SWR#-SWR2013-00178
Site Address: 12650 SW I-IAL1,BLVD PLM #,Pl,l\I2013-00297
TIGARD ---
Parcel#: 2S101BCO2401
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s 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 1 1 1 1
live Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 2 4 2 4
-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 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 2 4 2 4
Sink:
-1,av/Bar-Non-Food Related 2 0 0 2 4 2 4
- 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 0 0 0
Water Extractor 6 - 0 0 0 0 0
Water Closet-Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped [DU Credit 0
7'O'1:-\I,S 0 0 0 0 9 25 9 25
Current Fixture Value 25 divided by 16= 1.563 Current[DU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 25 divided by 16= 1.563 over (under) $ 7,488.00
Enter EDU Change Here 1.560
Notes:
Authorized Name/Signature: 11RANDEN'1 AGGAR'l'/Revised 9/4/13 by Dadamski Date: 7/26/2013
Building Division
Note: The property owner shall retain the ORIGINAL 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:\Budding\Sewer Tally\Scwer'l'allyShect_4Rllu._O7o 113.xlsx
'"tai8 .
Y Accumulative Sewer Tally
`,, R# SWIt2013-00178
s Tenant Name: SNYDER ROOFING SWR
Site Address: 12650 SW HAIL BLVD Pl,,M # PLM2013-00297
IBMWS Parcel#: 2S101BCO2401
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 0 0 0
Car Wash: - [Itch Stall 6 0 0 0 0 0
•
- Drive through 16 0 _ 0 0 0 0
Cuspidor/Water Aspirator 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 0 .el' .2' 0 1 2
Drinking Fountain 1 0 ` 1 i 1 1
Eve Wash 1 0 0 0 0
Floor Drain/Sink: -2 inch 2 4✓ lVv ,i3' . f/ Lt _ 3 6
-3 inch 5 1 0 0 0
-4 inch 6 �0 0 0 0 0
— -- -Car Wash -----6 -- -- _O__ -- t— -0- ---- 0 -- -0- --
Garbage Disposal: l )
- Domestic(to 3/4 I-IP) 16 0 VV 0 _ 0 0 0
-Commercial(to 5 I-IP) 32 , th 0 0 0 0 0
- Industrial (over 5 I IP) 42 \/ 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 I/ 0 / 0 0 0 0
Oil Sep(Gas Station) 6 v 0/� I 0 0 0
Rec. Vehicle Dump station I 16 ({� . 0 0 0 0
Shower: -Gang(per head) 1 I. 0 _ 0,__ 0 0
Stall 2 1\,.0 0 -'4 �! 2 4
Sink: j
u
-Lav/Bar-Non-Food Related 2 \/ 0 0 d(2/ 19' if 10
- Bradley 5 \r 0 0 0 0 0
-Com/Sery/Util- Food Related 3 0 0 I 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 a./ le o. 18
Urinal 6 0 0 0 0 0
Previous EDU Count A 0 0
Capped EDU Credit 0
'IOTA].S 0 0 0 0 15 .4'1/.2-1 15 41
Current Fixture Value 41( i„ divided by 16= s 'r Current[DU 1 EDU= $4,800.00
Previous Fixture Valu 0 divided by 16= /'74" 0.000 Previous EDU
Change divided by 16= over (under) S .2
Enter EDU Change Hererl
0 e
7<</gg`
Notes: /e ti(p
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 7/26/2013
Building Division .
rote: 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_4800_070113.xlsx