Permit V CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2010 00158
1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010
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Parcel: 2S113AB01201
Jurisdiction: TIGARD
Site address: 16290 SW UPPER BOONES FERRY RD
Project: Dow Aerosciences Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project Description: 1.9 EDU increase
Contractor: Owner: PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE: PHONE: 503 - 624 -6300
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/12/2010 $7,790.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.9
Total $7,790.00
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 - •ended for .re the 180 days. ATTENTION: Oregon law requires you to follow the rules adopt-d by the Oregon Utility Notification
Cente Those rules are sit • •h in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a d.py of t• - • e or direct questions
to 0 C by calling 503.232.1 y7 or 1 ; • b.332.2344.
Is -ued By: Permittee Signature: '
IP
Call 503.639.4175 by 7:00 a.m. for the next available ins • =ction • -te.
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 Parcel # 2S113AB01201
Tenant Name: Dow Aerosciences This SWR# 2010 -00158
Site Address: 16290 SW Upper Boones Ferry Rd This PLM# 2010 - 00213
Fixture Value Previous Previous Credits Cappcd Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s 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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 4 8 4 8
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 1 -IP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 1 -IP) 42 0 0 0 0 0
Ice Machinc /Refrigerator Drain 1 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 - Bar /Lavatory 2 0 0 9 18 9 18
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
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 EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 15 31 15 31
Current Fixture Value 31 divided by 16 = 1.9 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 31 divided by 16 = 1.9 over (under) 5 7,790.00
Enter EDU Change Here 1.9
Notes:
Authorized Name /Signature: Debbie Adamski Date: 11/12/2010
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 \Sewer l'allySheet- 3600.xls 06/25/08