Permit (242) CITY OF TIGARD SEWER CONNECTION PERMIT
.1111
2 COMMUNITY DEVELOPMENT Permit#: SWR2016-00501
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/03/2017
TIGARD 9 Parcel: 2S112DC01400
Jurisdiction: Tigard
Site address: 15865 SW 74TH AVE 110
Project: SC Labs Subdivision: FANNO CREEK ACRE TRACTS Lot: 4
Project Description: .69 EDU increase.
Contractor: Owner: JDS LLC
CRITERION CREEKVIEW LLC
BY SPECTRUM REAL ESTATE ADVISORS
1125 SE DIVISION ST#209
PORTLAND, OR 97202
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/30/2016 $3,657.00
Type of Use: SF
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .69
Total $3,657.00
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 wit '. .. s of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adop . by the Orego Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain copy of the rules ..r direct questions
to OUNC by c ing 50 . 32.1987 or 1.800.332.2344.
Issued B : / Permittee Signature:
Anto,
Call 503.639.4175 by 7:00 a.m.for the next available inspecti. .at,
This permit card shall be kept in a conspicuous place on the job site until • pl/on •1 the project.
Approved plans are required on the job site at the time of eac ins•ecti
Accumulative Sewer Tally
II
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Tenant Name: SC LABS SWR# 2016-00501
Site Address: 15865 SW 74TH AVE PLM# 2016-00635
TIGARD
Parcel#: 2S 112DC01400
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: -F,ach 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 01 5 1 5
-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 IIP) 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:
-L,av/Bar-Non-Food Related 2 0 0 3 6 3 6
-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 Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous I'sDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 4 11 4 11
Current Fixture Value 11 divided by 16= 0.688 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 11 divided by 16= 0.688 over (under) $ 3,657.00
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: BRANDEN TAGGART X2449 Date: 12/28/2016
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 PallySheet_5300_070116.xlsx