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Permit • CITY OF TI GARD SEWER CONNECTION PERMIT ik DEVELOPMENT SERVICES PERMIT #: SWR2004 - 00309 F - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/21/2004 SITE ADDRESS; 07307 SW BEVELAND RD PARCEL: 2S101AB 01604 SUBDIVISION: HERMOSO PARK ZONING: MUE BLOCK: LOT: 016 JURISDICTION: TIG TENANT NAME: GILROY OFFICE BUILDING USA NO: FIXTURE UNITS: 37 CLASS OF WORK: NEW DWELLING UNITS: TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: 2.3 EDU increase Owner: FEES PAT GILROY 5100 SW MACADAM AVE SUITE 240 Description Date Amount PORTLAND, OR 97239 [SWUSA] Swr Connectic 12/21/2004 $5,750.00 [SWUSA] Swr Connectic 12/21/2004 $0.00 Phone: 503- 225 -5559 [SWINSP] Sewer Inspeci 12/21/2004 $45.00 [ SWINSP] Sewer Inspeci 12/21 /2004 $0.00 Contractor: Total $5,795.00 Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you • ollow rul- :dopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0011 throug • ' 1 95 001 - 0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 .699 Issued by: �t�L1 C � ! / �/fi Permittee Signature: � A _ ,P Call (503) 639 - 4175 by 7:00 P.M. for an inspection needed the next business day Accumulative Sewer Tally Parcel # 2S101AB -01604 Tenant!Nwe: Gilroy Office Building This SWR #2004 -00309 Site Address: 7307 SW Beveland St This PLM# 2004-00177 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 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 1 5 1 5 - 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 4 8 4 8 - 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 4 24 4 24 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 9 37 9 37 Current Fixture Value 37 divided by 16 = 2.3 Current EDU 1 EDU = $ 2,500 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 37 divided by 16 = 2.3 over (under) $ 5,750.00 Enter EDU Change Here 2.3 Notes: Signature: Date: 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.xls 7/1/04 Accumulative Sewer Tally Parcel # 2S101AB -01604 Tenant Name: Gilroy Office Building This SWR;k2004 -00309 Site' \ddress: 7307 SW Beveland St This PLM# 2004 -00177 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 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 1 5 1 5 - 4 inch 6 0 0 0 0 0 - Car Wash Drr 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 4 8 4 8 - 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 4 24 4 24 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 9 37 9 37 Current Fixture Value 37 divided by 16 = 2.3 Current EDU 1 EDU = $ 2,500 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 37 divided by 16 = 2.3 over (under) $ 5,750.00 Enter EDU Change Here 2.3 Notes: Signs re: Date: l b l 16c1 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. i:\Building\Sewer Tally \SewerTallySheet.xls 7/1/04