Permit CITY OF TIGARD SEWER CONNECTION PERMIT
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1 • COMMUNITY DEVELOPMENT Permit#: SWR2015-00005
13125 SW Hall Blvd.,Ti Date Issued: 01/22/2015
T i to A i� and OR 97223 503.718.2439.l.� Tigard 2S112DD00701
Jurisdiction: Tigard
Site address: 15800 SW UPPER BOONES FERRY RD 300
Project: Jean Battig Veterinary Clinic Subdivision: 1994-006 PARTITION PLAT Lot: 2
Project Description: .63 EDU increase
Contractor: Owner: PACTRUST
15350 SW SEQUOIA PKWY S 300
TIGARD, OR 97224
PHONE: PHONE: 503-624-6300
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/22/2015 $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 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. Those rules are 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 by calling 5 .232.1987 or 1.800.332.2344.
Issued By: 4 ' Permittee Signatu y D — 4kalltft_
Call 503.639.4175 by 7:00 a.m.for the next available ins••ction date.
This permit card shall be kept in a conspicuous place on the job site until co • •Ietion of the project.
Approved plans are required on the job site at the time of each inspec'•n.
gi Aumulative Sewer Tally
'Tenant Name: Jean Battig Veterccinary Clinic SWR# 2015-00005
Site Address: 15800 SW Upper Boones Ferry Rd PLM# 2015-00019
Parcel#: 2S112DD00701
Fixture Value 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 Il, 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 I) 0 0 0
Dishwasher: -Commercial 4 0 I I 0 0 0
-Domestic 2 0 II 0 0 0
Drinking Fountain 1 0 II 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 2 4 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 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 O 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
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 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 1 6 1 6
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 3 10 3 10
Current Fixture Value 10 divided by 16= 0.625 Current EDU 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 Adamski Date: 1/22/2015
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.
1:\Building\Sewer Tally\SewerTallyShcet_490K)._070114.xlsx