Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT
Permit#: SWR2014 00030
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/08/2014
I[G A R O Parcel: 2S 101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 135
Project: Tigard Make-Ready Subdivision: 72ND BUSINESS CENTER Lot: 13
Project Description: .13 EDU increase
Contractor: Owner: PNWP LLC#2
BY PACIFIC NW PROP LTD PTNSP
PO BOX 2206
BEAVERTON,OR 97075
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/08/2014 $624.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $624.00
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. se rue e set forth in OAR 952-001-0010 through OAR 952-001-0090. ajn a copy of the rules or direct questions
to OU by calling 503.232.1•: •r 800.332.2344. `\
I sued By: .6.011" I Permittee Sign e: r_e-t
Call 503.639.4175 by 7:00 a.m.for the next available inspe ' 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: Tigard Make-Ready SWR# 2014-00030
tII�
Site Address: 13535 SW-2nd .Ave,Suite 135 PLM# 2014-00100
.\
Parcel#: 2S101DC00200
Fixture Value Previous Previous Credits (:tipped Fixture Fixture New New
# value count capped# ,due count Added:_ added value total#s total values
Baptisery/Font 4 0 (1 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 0, 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 0 0 0
-4 inch 6 0 0 0 0 0
-Car Wash 6 U 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 HP) 16 II 0 0 0 0
-Commercial(to 5 IIP) 32 U 0 0 0 0
-Industrial(over 5 IIP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
Living Unit 16 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 U 0 0 0
-Stall 2 0 II 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 11 0 0 0 0
Urinal 6 II 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16= 0.125 Current I(1)I. 1 EDU = $4,800.00
Previous Fixture Value I I divided by 16= 0.000 Previous 1:DU
Change 2 divided by 16= 0.125 over (under) S 624.00
Enter EDU Change Here 0.130
Notes:
Authorized Name/Signature: Debbie Adamski Date: 4/7/2014
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\Sewer 1'allyShcet_4800._070113.xlsx