Permit CITY OF TIGARD SEWER CONNECTION PERMIT
C : COMMUNITY DEVELOPMENT Permit #: SWR2013 -00105
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2013
Parcel: 25101 DC04500
Jurisdiction: Tigard
Site address: 7555 SW TECH CENTER DR A
Project: LaCie, LTD Tenant Improvement Subdivision: TECH CENTER BUSINESS PARK Lot: 1
Project Description: 3.31 increase
Contractor: Owner: SUMMIT PROPERTIES INC
5550 SW MACADAM BLVD STE 205
PORTLAND, OR 97201
PHONE: PHONE:
FAX:
• FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/23/2013 $15,441.15
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units:
Number of Dwelling Units: 3.31
Total $15,441.15
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 a copy of the rules or direct questions
to OUNC by calling 503.23,2.1987 .r 1.800.332.2344.
Issued By: 121:ar 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 11 111111
e - "Tenant Name: I.aCie SWR # 2013 -00105
TIGARD Site Address: 7555 Tech Center Dr., Tigard, OR 97223 PLM # 2013 -00136
Parcel #: 2S101DC04500
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #s value count added # added value total #s total values
Baptiscry /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 6 12 2 4 -4 -8
- 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 HP) 16 0 0 0 0 0
- Commercial (to 5 I IP) 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 Scp (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 4 8 4 8
- 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 6 36 6 36
Urinal 6 0 0 2 12 2 12
Previous EDU Count 0 0
Capped EDU Credit 0
TO"G11..S 0 0 6 12 16 65 10 53
Current Fixture Value 53 divided by 16 = 3.313 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 53 divided by 16 = 3.313 over (under) S 15,441.15
Enter EDU Change Here 3.310
Notes:
Authorized Name /Signature: Shirley Treat Date: 05/01/2013
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.
l:\ Building \ Sewer Tally \Scwcrl'allyShcct- 4665.xls 07 /01/12