Permit (119) CITY OF TIGARD SEWER CONNECTION PERMIT
' COMMUNITY DEVELOPMENT Permit#: SWR2017-00400
T E GA1 eD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/11/2017
Parcel: 2S102AB02402
Jurisdiction: Tigard
Site address: 12501 SW MAIN ST
Project: Spec Space Subdivision: ELECTRIC ADDITION TO TIGARDVILLE Lot: 15
Project Description: 1.25 EDU increase.
Contractor: Owner: VIZUMA LLC
5611 NE COLUMBIA BLVD
PORTLAND, OR 97218
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/11/2017 $6,875.00
Type of Use: CMS
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.25
Total $6,875.00
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 ru- adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may ;.•.i:i 4 a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800/2.2344.
II
Issued By: / /A �1 •- mittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspe• i.date.
This permit card shall be kept in a conspicuous place on the job site until c•mpletion of the project.
Approved plans are required on the job site at the time of eac inspection.
II I Accumulative Sewer Tally Tenant Name: SPEC SPACE SWR# 2017-00400
T t G A x D Site Address: 12501 SW MAIN ST. PLM# 2017-00504
Parcel#: 2S102AB02402
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 5 20 5 20
-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
Eye 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
-4inch 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 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 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/Sery/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 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 1 6 6 26 5 20
Current Fixture Value 20 divided by 16= 1.250 Current EDU 1 EDU= $5,500.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 20 divided by 16= 1.250 over (under) $ 6,875.00
Enter EDU Change Here 1.250 *
*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:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 12/6/2017
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
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
r
I:\Building\Sewer Tally\SewerTallySheet_5500_070117.xlsx