Permit (9) CITY OF TIGARD SEWER CONNECTION PERMIT
aJ COMMUNITY DEVELOPMENT Permit#: SWR2015-00225
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/31/2015
Parcel: 1 S134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 500
Project: Express Employment Professionals Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: .13 EDU increase
Contractor: Owner: ROBINSON, CONSTANCE A
BY KILLIAN PACIFIC LLC
500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/30/2015 $663.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $663.00
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. Those ru re 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 ing 503.232. 87 or 1.800.332.2344.
Issued y: Permittee Signatur
/ L
Call 503.639.4175 by 7:00 a.m.for the next available inspection
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 Mane: [r:xpress I?mplovmenr Professionals SWR # 2015-00225
Site Address: 10115 SW Nimbus Ave#500 PL\1 # 2015-00=432
a "
2
Parcel#: 1S113AA01900
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count cap ped#s value count added# added value total#s total values
Ba prisery/Dont 4 0 0 0 0 0
Rath: -Tub/Showcl- 4 0 - 0 0 0 0
jacuzzi/WI1i1-1 pool 4 0 0 0 0 0
Car Wash: -Bach 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: -Comnpercial 4 0 0 0 0 0
Domestic 2 0 0 0 0 0
Dtiflkillg Founmin 1 0 0 0 0 0
I.\,c 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 Disposit]:
Domestic(to 3/4 1-11)) 16 0 0 0 0 0
Commercial (to 5 1-1 P) 32 0 0 0 0 0
Industrial (over 5 I-II') 42 0 0 0 0 0
Icc Machine/Rcfri orator Drain 1 0 0 0 0 0
Living Unit 16 0 0 0 0 0
Oil Sc p(Gas Station) 6 0 0 0 0 0
Rcc. Vchicic Dunp p 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
Bradlc�' 5 0 0 0 0 0
Com/Scry/Util- Food Rclated 3 0 0 0 0 0
Swinmping Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water-12;xtractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous 13DU Count 0 0
Cappcd 1--'I-)U Crcdit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16= 0.125 Current I`DU 1 EDU= $5,100.00
Previous FiXturC Value 0 divided by 16= 0.000 Previous I{DU
Change 2 divided by 16= 0.125 over (under) S 663.00
Enter EDU Change Here 0.130
Round I:DUs to rhe nearest I/100th: it count ending in.005 shall be rounded LIP ro.01,and it count ending in.014 or less shall be rounded down to.01.
N()tcs:
Authorized Name/Signature: Debbie Adanpski Date: 12/29/2015
Building Division
t ()te: The property owner shall retain the ORIGINA 1.sewer tally record. If credits exist,this docunpent will scree as a voucher which nutst be
submitted to the City id Tigard Building Division to redeem credits towards future system development charges.
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