Permit CITY OF TIGARD SEWER CONNECTION PERMIT
111111 C COMMUNITY DEVELOPMENT Permit#: SWR2013-00205
• TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/26/2013
Parcel: 1 S135BA00102
Jurisdiction: TIGARD
Site address: 10164 SW WASHINGTON SQUARE RD
Project: Hannah Pet Clinic Subdivision: MYERS ESTATES Lot: 5
Project Description: 5.06 EDU increase
Contractor: Owner: PPR SQUARE TOO LLC
PO BOX 847
CARLSBAD,CA 92018
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/26/2013 $24,288.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 5.06
Total $24,288.00
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 pended r ore the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Cen . Those rules are •-1 forth in OAR 952-001-0010 through OAR 952-001-0090. Y. o. al a copy of the rules or direct questions
to UNC by calling 503.232.1•:• or 1.332.2344. /
Issued By: � // � Permittee Signature: , f my/r
Call 503.639.4175 by 7:00 a.m.for the next available inspection •ate.
This permit card shall be kept in a conspicuous place on the job site unti completion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
p : Tenant Name: Hannah Pct Clinic SWR# 2013-00205
TIGARD Site Address:' 10164 SW Washington Square Rd. PI AI # 2013-00421
Parcel#:.1S135BA00102
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 _ 2' 8 2 8
-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/\\later 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
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 6 12 6 12
-
-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 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 4 8 16 32 12 24
-Bradley 5 0 0 0 0 0
-Cum/Sere/Util-Food Related 3 0 0 4 12 4 12
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 1 6 3 18 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'l'O'l'A1,S 0 0 5 14 34 _ 95 29 81
Current Fixture Value 81 divided by 16= 5.063 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 81 divided by 16= 5.063 over (under) S 24,288.00
Enter EDU Change Here, 5.060
Notes:
Authorized Name/Signature:'. Debbie:\damski Date:; 11/26/13
Building Division
Note: The property owner shall retain the ORIGIN A 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\Scwcr I'allyShcct_4800._1170113.xlsx