Permit Mil CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2014-00113
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2014
Parcel: 1S136DCO2504
Jurisdiction: TIGARD
Site address: 7295 SW DARTMOUTH ST
Project: Western Bikeworks Subdivision: HUNTER POLLOCK NO.2 Lot: G
Project Description: .25 EDU increase
Contractor: Owner: AMERICAN INDUSTRIES INC
1750 NW FRONT AVE STE#106
PORTLAND,OR 97209
PHONE
PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 10/27/2014 $1,225.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .25
Total $1,225.00
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 s • e, wit in <0 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules dopte, b t-- Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obta' a corny . rules or direct questions
to O ' - •y ca I • 4 .232.1987 .r 1.800.332.2344. I
Issued By:G� 1 / it /,,, Permittee Signature: -stalk
J Call 503.639.4175 by 7:00 a.m.for the next available inspect on dat'
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.
c
Tenant Name: Western Bikewur
Acks umulative Sewer Tally SWR# 2014-00113
T I G n K n Site Address: 7295 SW Dartmouth St PLM# 2014-00349.
Parcel#: 1S136DCO2504
,
Fixture \'a I tie 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 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/WaterAspirator 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 0 0 0
Eye Wash 1 0 0 0 0 0
l lour Drain/Sink: -2 inch 2 0 0 1 2 1 2
-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 11P) 16 0 0 0 0 0
-Commercial(to 5 I-IP) 32 0 0 0 0 0
-Industrial(over 5 11P) 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 1 2 1 2
Sink:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-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
TOTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 4 divided by 16= 0.250 over (under) S 1,225.00
Enter EDU Change Here 0.250
Notes:
Authorized Name/Signature: Debbie Adamski Date: 10/27/2014
Building Division
INote: 7 he property owner shall retain the ORIGIN;\1,sewer tall}'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.
1:\Building\Sewer'1'ally\Bar er fallySheet_4'A N)._070114.xlsx