Permit q CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2015-00048
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/06/2015
Parcel: 1S 136 DB02601
Jurisdiction: Tigard
Site address: 11606 SW PACIFIC HWY 250
Project: Dead God's Tattoo Subdivision: 2000-025 PARTITION PLAT Lot: 2
Project Description: .25 EDU increase.
Contractor: Owner: HWY 99 LLC
11606 SW PACIFIC HWY, STE 200
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/06/2015 $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 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. T se rules -re 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 y calling 503.2' .1• or 1.800.332.2344.
Issue y: Q\ / /,/ Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection •: e.
This permit card shall be kept in a conspicuous place on the job site until •.mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
Tenant Name: DEAD GOD'S TATTOO SWR# 2015-00048
Site Address: ]1606 SW PACIFIC HWY#250 PLM# 2015-00141
Parcel#: ISI36DB02601
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 I) 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 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 ; 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 U
-Commercial(to 5 HP) 32 0 0 0 0 0
-Industrial(over 5 HP) 42 0 II 0 0 0
Ice Machine/Refrigerator Drain 1 0 I) 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 U
Rec.Vehicle Dump station 16 0 I) 0 0 0
Shower. -Gang(per head) 1 0 II 0 0 0
-Stall 2 0 0 0 0 U
Sink:
-Lav/Bar-Non-Food Related 2 0 0 2 4 2 4
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 I) 0 0 0
Swimming fool Filter 1 0 I) 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 I)
Water Closet-Toilet 6 0 0 0 0 U
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) 1,225.00
Enter EDU Change Here 0.250
Notes:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 5/6/2015
Building Division
ote: The property owner shall retain the ORIGINAL,sewer tally record. If credits exist,this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
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