Permit CITY OF TIGARD SEWER CONNECTION PERMIT
"! to COMMUNITY DEVELOPMENT Permit#: SWR2013-00209
T1GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2014
Parcel: 1 S135DD01800
Jurisdiction: TIGARD
Site address: 11565 SW HALL BLVD 180
Project: Bella Institute Subdivision: METZGER ACRE TRACTS Lot: 32
Project Description: .88 EDU increase
Contractor: Owner: BKB PROPERTIES LLC
11255 SW DAVIES RD,APT 1014
BEAVERTON, OR 97007
PHONE
PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Sewer Connection Fee 12/11/2013 $4,224.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .88
Total $4,224.00
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. Th. - • - - 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 . calling 503.232.1•' .800.332.2344.
Iss •d By: 1 ¢, / y Permittee Signature:
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 until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
Tenant Name: Bella institute SWR# 2013-00209
i s Site Address: 11565 SW I Ia11 lily 4 PLM# 2(113-00424
Parcel#: 1S135DD01800
Fixture Value I'rcvious Previous ( rcdits (:appcd Fixture Fixture New New
# value count ,sped#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 I 0 0 0 0 0
Eye Wash 1 0 0 0 0 II
Floor Drain/Sink: -2 inch 2 0 ) 4 2 4 0 0
-3inch 5 0 I I 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 II 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 u
-Commercial(to 5 HI') 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 0 0 1 2 1 2
Sink:
-Lav/Bar-Non-Food Related 2 0 19 38 111 20 -9 -18
-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 4 24 4 24
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 21 42 18 56 _ -3 14
Current Fixture Value 1 I divided by 16= u.8 ) Current 11DU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 14 divided by 16= 0.875 over (under) $ 4,224.00
Enter EDU Change Here 0.880
Notes:
Authorized Name/Signature: Debbie Adamski Date: 12/4/2013
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\Sewer I'allyShcet_4800._0711113.xlsx