Permit .
a CITY OF TIGARD SEWER CONNECTION PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: SWR2007 -00180
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/18/2007
PARCEL: 1 S136CD -90000
SITE ADDRESS: 08060 SW PFAFFLE ST 200 ZONING: C -P
SUBDIVISION: CAMERON PLAZA LOT: JURISDICTION: TIG
PROJECT: LILE INTERNATIONAL
Project Description: 1.6 EDU increase.
TENANT NAME: LILE INTERNATIONAL
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 1.6
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
G3 LEASING LLC
19480 SW 118TH AVE Description • Date ,Amount
TUALATIN, OR 97205
[SWUSA] Sewer Connection Fee 7/18/2007 $4,480.00
Phone: 503- 691 -3500
Total $4,480.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
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 d ion . from the distance given.
If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will ins : I a late :1. ATTENTION: Oregon
law requires you to follow rules adopted by the Oregon Utility Notification Center. Tho • ru : are".. - fort. ' OAR 952 - 001 -0010 through
OAR 952- 001 -0100. You may obtain copies of these rules or direct questions to OU ∎. C by c.: (ling • 46.6699 or 1.800.332.2344.
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IssuedAye, Permittee Signature: /'i 1 ` `. ,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 # 1 S136CD -90000
Tenant Name: Lile IntemMuonal This SWRN SWR2007 -00180
Site Address: 8060 SW Pfaffle St. Tigard, OR 97223 This PLM# PLM2007 -00319
Fixture Value ' Previous Previous Credits Capped Fixture Fixture New New
N value capped off value added added total total
count off # s count N value N s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacrl77 ✓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 2 4 2 4
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 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 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 2 6 2 6
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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 8 26 8 26
Current Fixture Value 26 divided by 16 = 1.6 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 26 divided by 16 = 1.6 over (under) $ 4,480.00
Enter EDU Change Here 1.6
Notes:
Authorized Name /Signature: Savanna Newell Date: 7/18/2007
Building Division
'su N ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \Forms \SewerTallySheet.xls 02/02/07