Permit CITY OF TIGARD SEWER CONNECTION PERMIT
1,1 2 COMMUNITY DEVELOPMENT Permit#: SWR2014-00084
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2014
Parcel: 1S 126DC04700
Jurisdiction: Tigard
Site address: 9575 SW LOCUST ST
Project: Phoenix Inn Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: .63 EDU increase
Contractor: Owner: PIH TIGARD LLC
111 CONGRESS AVE#2600
AUSTIN,TX 78701
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/28/2014 $3,087.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .63
Total $3,087.00
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 issu-•> , o if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon,,o''' Notification
Center. •se rue -re set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain - •. of the rule�di •ct questions
to OU by calling 503.2 .1•: • 1.:00.332.2344.
I ued By: i /� itlikArdy Permittee Signet
Call 503.639.4175 by 7:00 a.m.for the next available inspection d- e. •�:�
This permit card shall be kept in a conspicuous place on the job site until comp = • of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
111 • Tenant Name: Phoenix Inn SWR# 2014-00084
Site Address: 9575 SW I...cust St PLM# 2014-00286
I IGAh1•
Parcel#: 1S126DC04700
Fixture \.iluc I'n∎u i- Previous Credits Gapped Fixture Fixture New New
value count capped#s \aloe 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 II 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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 3 6 3 6
-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 IIP) 16 0 0 0 0 0
-Commercial(to 5 IIP) 32 0 0 0 0 0
-Industrial(over 5 I IP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain I 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) I 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 Credit 0
TO'h,A1,S 0 0 0 0 5 10 _ 5 10
Current Fixture Value 11) divided by 16= 0.625 Current IEI)I 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 10 divided by 16= 0.625 over (under) $ 3,087.00
Enter EDU Change Here 0.630
Notes:
Authorized Name/Signature: Debbie:\damski Date: 8/25/2014
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 Tally\SewerI'ally5heet_4911)._070114.xlsx