Permit (48) CITY OF TIGARD SEWER CONNECTION PERMIT
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COMMUNITY DEVELOPMENT Permit#: SWR2016-00003
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/01/2016
Parcel: 1 S135BB00501
Jurisdiction: Tigard
Site address: 10575 SW CASCADE AVE
Project: Biamp Subdivision: OAKBURG Lot: 27
Project Description: TI-new structural partitions,doors&ceilings.
Contractor: Owner: ICON OWNER POOL 3 WEST LLC
BY INDCOR PROPERTIES
2 NORTH RIVERSIDE PLAZA, STE 235
CHICAGO, IL 60606
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/01/2016 $21,675.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 4.25
Total $21,675.00
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. Tho 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 OLIN y calling 503.2 19 or 1.800.332.2344.
Iss d By: c Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection te.
This permit card shall be kept in a conspicuous place on the job site until com letion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
� "1'cnant Name Biamp
SWR# 2016-00003
Site.\ddress: 10575 SW Cascadc.1ve ITNI# 2016-00021
Parcel#: 1S135BB00501
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Ba tiler•/Dont 4 0 0 0 0 0
Bath: -'I'ub/Shower 4 0 0 0 0 0
—jacuzzi/Whirlpool 4 1 0 0 1 0 0 0
Car Wash: -Flach 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
Fvc Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 6 12 6 12
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 3/41 IP) 16 0 0 0 0 0
-Commercial to 5 11P 32 0 0 0 0 0
Industrial over 5 1 IP 42 0 0 0 0 0
Ice'\lachine/Refri orator 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 1 1 0 0 1 0 0
Stall 2 0 0 2 4 2 4
Sink:
Lav/Bar-Non-Food Related 2 0 0 8 16 8 16
Bradley 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 Fxtractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 5 30 5 30
Urinal 6 0 0 1 6 1 6
Previous F.DU Count 0 0
Capped FDU Credit H0
0 0 0 0 22 68 22 68
Current Fixture Value 68 divided by 16= 4.250 Current FDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous FDL'
Change 68 divided b\ 16= 4.250 over (under) S 21,675.00
Enter EDU Change Here 4.250
*Round I?DUs 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: Dcbbic,\damski Date: 1/21/2016
Building Division
ote: 1'he property owner shall retain the ORIGIN-\1,sewer tally record. if credits exist,this document will serve as a voucher which must be
submitted to the Cit, of'1'igard Building Division to redeem credits towards future system development charges.
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