Permit CITY OF TIGARD : ; SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2011 -00051
I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
TIGARD
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: 1.3 EDU increase. 6/22/11, reprinted to add (2) additional lays.
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 04/06/2011 $5,330.00
Sewer Connection Fee 06/22/2011 $820.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.3
Total $6,150.00
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 • epy of • - rules direct questions
to OUNC by calli . - - 2.1987 • 1.800.332.2344.
Issued By: `_ Permittee Signature: At
6
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.
Accumulative Sewer Tally Parcel # 2S112DD00200
Tenant Name: Immunology* *REVISED 6/22/11 ** This SWR# 2011 -00051
Site Address: 15862 SW 72nd #150 This PLM# 2011 -00113
Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw
# value capped off value added added total total
count , tt " 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 u 0 0 0 0
- Drive through 16 0 0 0 0
Cuspidor /Water Aspirator 1 0 �a 0 0 0 0
Dishwasher - Commercial 4 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 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 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
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 10 20 10 20
- 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 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 12 24 12 24
Current Fixture Value 24 divided by 16 = 1.5 Current EDU 1 EDU = $ 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 24 divided by 16 = 1.5 over (under) $ 6,150.00
Enter EDU Change Here 1.5
Notes: * *REVISED, 6/22/11, ADDING (2) ADDITIONAL LAVS **
Authorized Name /Signature: Debbie Adamski, x2450 � f D ate: 4/6/2011
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\ SewerTallySheet- 4100.xls 07/01/10
CITY OF TIGARD SEWER CONNECTION PERMIT
"'� COMMUNITY DEVELOPMENT Permit #: SWR2011-00051
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2011
Parcel: 2S112DD00200
Jurisdiction: Tigard
Site address: 15862 SW 72ND AVE 150
Project: Immunology Subdivision: PACIFIC CORPORATE CENTER Lot: 0
Project Description: 1.3 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 04/06/2011 $5,330.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.3
Total $5,330.00
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 fot more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Those rules are set f.rth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy e the rules • questions
to OUNCE by calling 503.232. • • : or )1.:: '.332.2344
Issu By: k / G�! G Permittee Signature:
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.
Accumulative Sewer Tally Parcel # 2S112DD00200
Tenant Name: Immunology This SWR# 2011 -00051
Site Address: 15862 SW 72nd #150 This PLM# 2011 -00113
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count t! 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 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4inch 6 0 0 0 0 0
- Car Wash Dm 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
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 8 16 8 16
- 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 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 10 20 10 20
Current Fixture Value 20 divided by 16 = 1.3 Current EDU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 20 divided by 16 = 1.3 over (under) $ 5,330.00
Enter EDU Change Here 1.3
Notes:
Authorized Name /Signature: Debbie Adamski, x2450 Date: 4/6/2011
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 \SewerTallySheet- 4100.xls 07/01/10