Permit II CITY OF TIGARD SEWER CONNECTION PERMIT
' f* COMMUNITY DEVELOPMENT Permit#: SWR2014-00070
T f G A RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/04/2014
Parcel: 1S135ACO2500
Jurisdiction: Tigard
Site address: 9378 SW MANDAMUS CT
Project: LONGSTAFF APARTMENTS SALES OFFICE ADDITIC Subdivision: ASHBROOK FARM Lot: 25
Project Description: Interior plumbing for TI: Installing(1)lavatory,(1)water closet,and(1)water heater.
Contractor: Owner: MACH 1 GE-ASHBROOK LLC
851 SW 6TH AVE#1500
PORTLAND, OR 97204
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/04/2014 $2,450.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .5
Total $2,450.00
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 b the Oregon Utility Notification
Center. Those r set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obt• . a copy � t mules or direct questions
to OUNC by ing 503.232.1 7 or 1.:s:.3 .2344.
Issue By: ,i0.• Ii I ,, Permittee Signature: \A 11
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. 1
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: LONGSTAFF APARTMENTS SALES OFFICE SWR# 2014-00070
TiGnom
Site Address: 9378 SW MANDAMUS CT PLM# 2014-00242
Parcel#: 1 S 135ACO2500
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 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 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
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 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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 2 8 2 _ 8
Current Fixture Value 8 divided by 16= 0.500 Current EDU 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 8 divided by 16= 0.500 over (under) $ 2,450.00
Enter EDU Change Here 0.500
Notes:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 7/24/2014
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 CallySheet_4900._070114.xlsx