Permit 711I _ w CITY OF TIGARD SEWER CONNECTION PERMIT
;w. COMMUNITY DEVELOPMENT Permit #: SWR2012 -00007
13 125 SW Hall Blvd., Tigard OR 97223 503.718.2439
, Date - Issued: 01/20/2012
TIGARD 9
Parcel: 2S 112 DA01400
Jurisdiction: Tigard
Site address: 15350 SW SEQUOIA PKWY 380
Project: Spec Space Subdivision: 1996 -048 PARTITION PLAT Lot: 2
Project Description: .3 EDU increase
Contractor: Owner: PACIFIC REALTY ASSOCIATES
ATTN: N PIVEN
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
•
PHONE PHONE:
FAX:
l FEES
1 Description Date Amount
Specifics: Sewer Connection Fee 01/20/2012 $1,350.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units: 4
Number of Dwelling Units: .3
Total $1,350.00
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 - c• .y of t . u es o direct questions
to OUNC by calling 503. ' 2.1987 or 1.800.332.2344.
Issued By: // '—' I _ Permittee Signature:
s�� -mil
Call 503.639.4175 by 7:00 a.m. for the next available inspecti
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
v
Tenant Name: Spec.Space SWR # SWR2012 -00007 .
- Site Address: 15350 SW Sequoia'Pkwy, Ste. 380 r .- PLM # PLIL12012 =00016
ow-Mu*
Parcel #: 2S112DA01400 : -.
Fixture - - Value Previous- - Previous Credits - --- Capped- - Fixture- Fixture New New
# value count capped #s value count added # added value total #s total values
Bap tisery/ 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
Eve Wash 1 0 0 .. -, 0 0 0
Floor Drain /Sink: - 2 inch 2 ., , . 0 0 0 0 0
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 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 • 0 0 0 . 0
Sink:
- Lav /Bar - Non -Food Related 2 0 0 1 2 1 2
Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 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 2 4 2 4
Current Fixture Value 4 divided by 16 = 0.3 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 4 divided by 16 = 0.3 over (under) S 1,350.00 '
Enter EDU Change Here 0.3
Notes:
Authorized Name /Signature: Dianna Howse . ` . ' Date: 1/20/2012 - ' . , -
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- 4500.xls 01/18/12