Permit _ CITY OF TIGARD SEWER CONNECTION PERMIT
t n
>r# ° COMMUNITY DEVELOPMENT Permit#: SWR2015-00071
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/06/2015
Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7216 SW DURHAM RD 200
Project: Game Day Media Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 25-27,2;
Project Description: 3 EDU increase
Contractor: Owner: PACIFIC REALITY ASSOCIATES LP
ATTN: N PIVEN
15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Sewer Connection Fee 07/06/2015 $14,700.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 3
Total $14,700.00
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 - •ended • • ore the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Cente . Those rules are -t forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to 0,NC by calling 503.232.1•: •r :0!.332.2344.
I sued By: .4 4/ / Permitte Signature: �, Zr
Call 503.639.4175 by 7:00 a.m.for the next available inspect• date.
This permit card shall be kept in a conspicuous place on the job site u ' completion of the project.
Approved plans are required on the job site at the time of each inspection.
III Accumulative Sewer Tally
Tenant Name: Game Day Media SWR# 2015-00071
IGARI) Site Address: -216 SW Durham Rd#200 PLM# 2015-00207
I Pjrc(.l 2S113AC00103
Fixture A clue PI,c low- Previous Credits I.apped IAxture Fixture New New
_ ).ilue count capped#s c.due count added ti 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 I 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 (1 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 1-IP) 32 0 0 0 0 0
-Industrial(over 5 I IP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain I 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) I 0 0 0 0 0
-Stall 2 0 2 4 0 _ -2 -4
Sink:
-Lay/Bar-Non-Food Related 2 0 0 2 4 2 4
-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 II 0 0
Water Extractor 6 0 0 0 0 11
Water Closet-Toilet 6 0 0 6 36 6 36
Urinal 6 0 (I 2 12 2 12
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 4 10 52 8 48
Current Fixture Value 18 divided by 16= 3.000 Current EDU 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 48 divided by 16= 3.000 over (under) $ 14,700.00
Enter EDU Change Here 3.000
Notes:
Authorized Name/Signature: Debbie Adamski Date: 6/30/2015
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 TallySheet_4900._070114.xlsx