Permit (8) CITY OF TIGARD SEWER CONNECTION PERMIT
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COMMUNITY DEVELOPMENT Permit#: SWR2019-00294
Date Issued: 10/23/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 1 S134BC00300
Jurisdiction: Tigard
Site address: 12264 SW SCHOLLS FERRY RD
Project: Restore Cryotherapy Tigard Subdivision: None Lot: None
Project Description: Interior plumbing for TI:Capping(1)shower stall,(1)sink,and(1)water closet;Adding(1)drinking fountain,(3)2"
floor drains,(1)sink,and(1)clothes washer; Relocating(1)shower stall and(1)water closet.
Contractor: WESTERN PLUMBING Owner: FW OR-GREENWAY TOWN CENTER LLC
9460 SW TIGARD AVE SUITE 101 PO BOX 790830
TIGARD, OR 97223 SAN ANTONIO, TX 78279
PHONE: 503-639-5296 PHONE: 360-823-7223
FAX: 503-684-9015
FEES
Description Date Amount
Specifics: Sewer Connection Fee 10/23/2019 $1,798.00
Type of Use: SF
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .31
Total $1,798.00
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 503.232.1987 or 1.800.332.2344.
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Issued By: Permittee Signature: i
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Call 503.639.4175 by 7:00 a.m.for the next available inspection 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.
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Tenant Name: RESTORE CRYOTHERAPY
Sewer Tally SWR# 2019-00294
Site Address: 12264 SW SCHOLLS FERRY RD PLM# 2019-00423
TIGARD
Parcel#: 1S 134BC00300
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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 3 6 3 6
-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 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 1 2 0 -1 -2
Sink:
-Lav/Bar-Non-Food Related 2 0 1 2 1 2 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 3 10 6 15 3 5
Current Fixture Value 5 divided by 16= 0.313 Current EDU 1 EDU= $5,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 5 divided by 16= 0.313 over (under) $ 1,798.00
Enter EDU Change Here 0.310 *
*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 T AGGART X2449 Date: 10/17/2019
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.
I:\Building\Sewer Tally\SewerTallySheet_5800_070119.xlsx