Permit CITY OF TIGARD SEWER CONNECTION PERMIT
` 2 COMMUNITY DEVELOPMENT Permit #: SWR2011 -00049
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2011
Parcel: 2S112DA00800
Jurisdiction: Tigard
Site address: 15055 SW SEQUOIA PKWY 130
Project: Yecuris Subdivision: Lot: 0
Project Description: .7 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 03/29/2011 $2,870.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .7
Total $2,870.00
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. are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy .' the rules • direct questions
to OUN' by calling 503. .1 • :7 0 800.332.2344.
Iss ed By: Aggialtiff 4 Permittee Signature: / ,
'_
Call 503.639.4175 by 7:00 a.m. for the next available inspection da e.
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 # 2S112DA00800
Tenant Name: YECURIS This SWR# SWR2011 - 00049
Site Address: 15055 SEQUOIA PARKWAY SUI l'E 130 This PLM# PLM2011 - 00085
Fixture Value Previous Previous Credits Capped 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 1 4 0 -1 -4
- 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 1 2 3 6 2 4
- 3 inch 5 0 0 0 0 0
-4inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 I -IP) 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
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 2 4 1 2
Sink - Bar /Lavatory 2 0 4 8 7 14 3 6
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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 2 12 3 18 1 6
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0.6 9.6
TOTALS _ 0 0 9 28 16 48 7 10.4
Current Fixture Value 10.4 divided by 16 = 0.7 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 10.4 divided by 16 = 0.7 over (under) $ 2,870.00
Enter EDU Change Here 0.7
Notes: 3/29/11, Revised fixture count per property owner, PacTrust. Used sewer credit from SWR2007 -00176 Dadamski.
Authorized Name /Signature: BRANDEN TAGGART Date: 3/18/2011
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 I'allySheet- 4100.xls 07/01/10