Permit (180) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2016-00005
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/27/2016
Parcel: 1 S 126CA00300
Jurisdiction: Tigard
Site address: 9385 SW GREENBURG RD 100
Project: Rose City Barbell Subdivision: FAIRVIEW PLACE CONDO Lot: 20
Project Description: TI for new tenant:Converting existing retail space to a gym. Adding a bathroom and storage room.
Contractor: Owner: SFP-F LLC
ATTN: PROPERTY TAX ACCOUNTING
PO BOX 5350
BEND,OR 97708
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/27/2016 $3,519.00
Type of Use:
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $3,519.00
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 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 ling 32.1987 or 1.800.332.2344. r
Issued B : �15 2A )./ 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
Tenant Name:Rose City Barbell SWR# 2016-00005
Site Address: 9385 SW Grccnburg Rd 111-.11# 2016-00029
Parcel#: 1 S 126CA00300
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Ba tisery/Font 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
acuzzi/Whirlpool 4 0 0 1 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 1 1 1 1
Eve 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 IIP 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 Se 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 1 2 1 2
Sink:
Lav/Bar-Non-Food Related 2 0 0 1 2 1 2
-Bradlev 5 0 0 0 0 0
-Com/Sery/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 0Ej 0
Capped EDU Credit 0
TO'1';�LS 0 0 0 0 4 11 4 11
Current Fixture Value 11 divided by 16= 0.688 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 11 divided by 16= 0.688 over (under) 3,519.00
Enter EDU Change Here 0.690
*Round EDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: Debbie Adamski Date: 1/27/2016
Building Division
ote: 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:ABuilding\Sewer T'allyASewed'allvSheet_5100_070115.xlsx