Permit p CITY OF TIGARD SEWER CONNECTION PERMIT
111 a COMMUNITY DEVELOPMENT Permit a: SWR2014-00074
-f R.; RO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/18/2014
Parcel: 1 S134AA01800
Jurisdiction: Tigard
Site address: 10240 SW NIMBUS AVE L9B
Project: Smith&Nephew Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 2
Project Description: .13 EDU increase
Contractor: Owner: HANSON, RONALD D
ROBINSON,CONSTANCE A
ROBINSON,CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK,WA 99331
PHONE: PHONE: 503-598-9980
FAX:
FEES
Description Date Amount
Specifics:, Sewer Connection Fee 08/18/2014 $637.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $637.00
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 suspende. • more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Th• - rules are et forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC • calling 503.232.1'87 = 800. 2.2344.
lssu=• By: �i �r / / 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.
IIIII Accumulative Sewer Tally
I Tenant Name: Smith&Neph cw SWR# 2014-00074
T I G A H D Site Address: 10240 SW\imbus Ave PLM# 2014-00271
Parcel#: 1S 134AA01800
Fixture \ .1 I 1]. Previous Previous Credits Capped I.ixture Fixture New New
# value count capped#s %,due 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 11 0 0 0 0
Cuspidor/Water Aspirator 1 II 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 0
-Domestic 2 II 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 I IP) 32 0 0 0 0 0
-Industrial(over 5 I IP) 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 0 0 0
Sink:
-Lav/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 Credu 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16= 0.123 Current EDU 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 2 divided by 16= 0.125 over (under) S 637.00
Enter EDU Change Here 0.130
Notes:
Authorized Name/Signature: Debbie.ldamski Date: 8/14/2014
Building Division
Note: 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.
I:\Building\Sewer Tall y\ScwerTallySheet_4900._070114.xlsx