Permit CITY OF TIGARD SEWER CONNECTION PERMIT
at
COMMUNITY DEVELOPMENT Permit #: SWR2013 -00075
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/01/2013
Parcel: 1 S136DA00100
Jurisdiction: Tigard
Site address: 11308 SW 68TH PKWY
Project: Comcast Tech Ops West Subdivision: PFAFFLE PLAZA CONDO Lot: 2
Project Description: EDU 1.0
Contractor: Owner: BENENSON 68TH PARKWAY KEY LLC, T
BY PROVIDENCE HEALTH SYSTEM
ATTN: PROPERTY MANAGEMENT
1235 NE 47TH STE 160
PORTLAND, OR 97213
PHONE
PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/01/2013 $4,665.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.
Total $4,665.00
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 adop d by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a co of the r s or direct questions
to OUNC by calf • : 83.232.1987 or 1.800.332.2344.
D
Issued By: - L, ,• Permittee Signature: / V (AA 2 �A
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
Tenant Name: Comcast Tech Ops Ctr SWR # 2013 -00075
Site Address: 11308 SW 68th Parkway PLM # 2013 -00104
TICARI)
Parcel #: 1S136DA00100
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total 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 1 1 0 -1 -1
1syc Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 13 26 0 -13 -26
- 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 III') 16 0 0 0 0 0
- Commercial (to 5 I IP) 32 0 0 0 0 0
- Industrial (over 5 I IP) 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
Rcc. 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:
- l.av /Bar - Non -Food Related 2 0 0 8 16 8 16
- Bradley 5 0 0 0 0 0
- Com /Serv/Util - Food Related 3 0 0 1 3 1 3
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 1 6 1 6
Urinal 6 0 0 3 18 3 18
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 _ 14 27 13 43 -1 16
Current Fixture Value 16 divided by 16 = 1.000 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 16 divided by 16 = 1.000 over (under) S 4,665.00
Enter EDU Change Here 1.000
Notes:
Authorized Name /Signature: Shirley Treat Date: 03/27/2013
Building Division
ote: 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.
r
I: \Building \Sewer Tally \Sewer I'allySheet- 4665.xls 07/01/12