Permit CITY OF TIGARD SEWER CONNECTION PERMIT
NI to COMMUNITY DEVELOPMENT Permit#: SWR2014-00041
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/14/2014
Parcel: 2S102AD01900
Jurisdiction: Tigard
Site address: 8935 SW BURNHAM ST
Project: TVF&R Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: 1.5 EDU increase.
Contractor: Owner: TUALATIN VALLEY FIRE&RESCUE
11945 SW 70TH AVE
TIGARD,OR 97223
PHONE: PHONE: 503-259-1188
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/14/2014 $7,200.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.5
Total $7,200.00
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 suspe •'. • •.re the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Th• e rules are s:t forth OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC b calling 503.232.19.7 - 1.:00. 2 .2344.
Issued '•y: Permittee Signature: ( - i _ /GL/
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.
Accumulative Sewer Tally
;li' . Tenant Name: TVF&R,FIRE STATION 51 SWR# 2014-00041
Site Address: 8935 SW BURNT I.\\I RI) PLM# 2014-00139
1 i,, ,r i,
Parcel#: 2S 102AD01900
Fixture \Alin Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s t otal value
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 II
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 1 2 3 6 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 Il
Garbage Disposal:
-Domestic(to 3/4 TIP) 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
Living Unit 16 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:
-Lav/Bar-Non-Food Related 2 0 0 2 4 2 4
-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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 2 9 26 8 24
Current Fixture Value 24 divided by 16= 1.500 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change_ 24 divided by 16= 1.500 over (under) $ 7,200.00
Enter EDU Change Here 1.500
Notes:
Authorized Name/Signature: Debbie Adamski Date: 7/29/2014
Building Division
Note: The property owner shall retain the ORIGIN.\L 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\Sewer l'allySheet_4801._070113.xlsx