Permit ,, "'' SEWER CONNECTION PERMIT
il''!' CITY OF TIGARD
a COMMUNITY DEVELOPMENT Permit#: SWR2015 00160
TIGARD,I13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/30/2015
q4.. Parcel: 2S101AA02300
Jurisdiction: Tigard
Site address: 12190 SW 69TH AVE
Project: Tran Subdivision: WEST PORTLAND HEIGHTS Lot: 22
Project Description: .25 EDU's for home occupation beauty salon
Contractor: Owner: TRAN, GINA
12190 SW 69TH AVE
TIGARD, OR 97223
PHONE: PHONE: 503-421-8628
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/30/2015 $1,275.00
Type of Use: SF
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .25
•
Total $1,275.00
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 r_ -s 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 b. a ling 503. ' .19: or 1.800.332.2344. ._
Issu d By: j 0 ' Permittee Signa re:
1 _er/fi !��`
Call 503.639.4175 by 7:00 a.m.for the next available inspec'•n date.
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
C 4 Tenant Name: 'Fran Beauty Salon SWR# 2015-00160
,t r , Site Address: 12190 SW 69th Ave PLM# 2015-00266
ii11711.-CifiVRO
Parcel#: 2S101AA02300
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 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
Lye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-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 IIP) 32 0 0 0 0 0
-Industrial (over 5 I-IP) 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 0 0 0
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 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 F,DU Count 0 0
Capped [DU Credit 0
TOTALS 0 0 0 0 2 4 2 4
Current Fixture Value 4 divided by 16= 0.250 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous HDU
Change 4 divided by 16= 0.250 over (under) $ 1,275.00
Enter EDU Change Here 0.250 *
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes: This is a residential address with a home occupation for a beauty salon. Per CWS,they arc to be charged SDC fees.
Authorized Name/Signature: Debbie Adamski Date: 11/30/2015
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. I f 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:ABuilding\Sewer Tally AScwer'l'allyShect_5100_)70115.xlsx