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9370 SW GREENBURG RD #201
RECEIVED
'i �gco� -Oncq;;)- MAR 15 )00h
lkum-bing 1!ermit AppAication As
Cfty of n- gwd 1,5011.DiN(z ra'-,I
13125 SW H213 Blvd.,ngvd,OR 47123A�P
I'l-om 503.639.4171
FIRR 503.5".1960 an-P..j,N.A'
2A-Hourinspecaloolinu 503.639.4175
Internet: vrfWWxz.bvLr".US IMi Pumd)49r. I f'r
S.RPM-aw I arw 00.
771--.
Y'.fiiSt� ?':rT'11' [F rsr1�' �----rr • pc.•� !'°, .: .+e,,r.N;•
- f " e..
J. ... I;Sr
;
0 Nt*("aitswum n Dmt"iom
t- Isy weMoVi(includes 100 ft.for cach utility-
SFR(1)bath 249.10
0 1-
and 7-havily 4*eUbiS SFR(2)bath oo
C3A---y building 0 muid-ftmiay SM(3)balb —H99.00
rMaw builft- ❑Chbcr; I Each additional ba0iAnchm 1-45.00
,I
Fi-tpfiftklw C- sq ft-)
Sao Utilities
lob alta ad&*2,. Cateh basin or aro dram 16.60
— i��9 0 6Te I --&�i ----160
awsinwim" -Iin PA-Y-� __j or h"Ch ejava—
De. &qfS. rooting drain(m. Pale 2
Mamtlttelmed I- utilities 110.00
Q=%xurvelldiroeboutc ID jab site
Manholes 16.60
Rain drain connecior 16.60
Cku-i Sanitary new=(mo.linear ft.:__) P;lcc-
�Vmnv-ewer(no.11ricar ft.:_ )
am vice(UCL linear Q.:
Subdivi3ion: 2ia-bi --
Fixftre or Item
Tax MAP/P-Cld DDL' T)h Absorption valve 16.60
p% F.
Dsd&ow pre par 2
:L Backwater valve 16.60
00111CL W26hCr 16.60
16.60
Drinkint fountain 16.60
Nww. Ejectlyrs/mirrm 16.60
Expansion tank 16.60
Address:: FIXWW."Wn Car 16-60
floor drairiffincir sink/hub 16 W
GarbaM disposal WIND
Hose bib
16.60
Ice make 16,60
Btlavan [tlttteepnn/greaac trap 16.60
Cnanct MML, Medical gas(v31 ur-I Post 2
Addmu:24S - Ptirner I&GO
DR D
ofAtatozip —,?,I 3 ROOF drain(CommCmial) 1640
Maw- F—. 7 0q) tp Sink/brrsi story 16.60 )(1-(P 0
Tublihowew0lowtr pan 16.60
E�rril: Unna v16.40
Wow closet 16.60
Bas)ans urate JA Wawr heater 16.60
Sp-3
7.2 17 Sublool
minkrm'"Pat*fre, 4n.50
pb'—(-e;B --7 q U I/ 416Z
r-C)3'j-- Do 84.41, Pluutbing Lir-m.:
CAJ PA& I Plan review (25%t-1 vtfmf,fee)
Suft sumtow(1191 v, *d)
Print saltie
This pervit appUrAlleft expom K a pwraft is not obtaivetvAthin
090 ds"after it be%been accepted me complete.
lree frilthcdology-,;ct by Tri-Counry Building Industry Servire 11bact
613996812FOG o:j 2-j i qwri T d i3Pe:3Se3 d60 :21 *l" S1 Jew
CITY OF TIGARD ELECTRICALPERM!T
PERMIT#. ELC2004-00122
DEVELOPMENTS[ WICES DATE ISSUED: 3117104
13125 SW Hall Blvd., Tigard, OR 97223 (50',) 639-4171 PARCEL: 1S126DB-02800
FITF ADDRESS. 09376 SW GREENBURG RD 201 ZONING: C-f
SUBDIVISION: PP1991-018
BLOCK: LOT : 001 JI RISDICTION: TIG
Project Description: Tenant Improvement
10�T_
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ _ MISCL LLANEOUS
00 SF OR LESS: U - 200 amp: PUMP/IRRIGATION:
EACH AL J'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 600 amp: SIGNAL/PANEL:
MANF MMI SVC/FDR: 661+amps - 1000 volts: MIN 0R LABEL (10):
_
SERVICE/FEEDER _ BRANCH CIRCUI IS ADD'L INSPECTIONS
0 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR "DR: I PEk NJUR:
4U1 600 amp: EA ADD'L_ BRNCH CIRC: 3 IN PLANT:
601 - 1000 amp: �— _ PLAN REVIEW SECTION
1000+arnplvolt: —4 RES UNITS. > 600 VOLT NOMINAL:
I Reconnect only__ _ SVC/FDR —225 AMPS:— CLASS AREA/SPEC OCC:
Owner: Contractor:
FRANKLIN COMMONS ASSOCIATES LEAR ELECTRIC
BY NORRIS+STEVENS PO BOX 573
52U SW 6Th STE 400 GRESHAM,OR 97030
PORTLAND,OR 97204
Phone: Phone: 665-9840
Reg #: LIC 00052271;
SUP 3786S
FEES f{Lf. 26-4110
C-.0ptlon Date Amount Regoired Inspections
SIA PRMT'j FILC Permit ? 1-ii-I $66.80 -----�
jELPLC'Kj FIS'Nn Re Iq $16.70 Rough-In
[TAX)99%,State Surcharge I irk $5.34 Elect'l Final
Total $88.84
This Permit is issued subject'o the regulat:ons contained in the Tigard Municipal Code,State of OR. Specialty Codes and all other applicable laws.
A!I work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuanob,or if work is
Euspended for more than 180 days ATTENTION 01 sgon law requires you to follow rules adopted by the Oregon Utility Notification Center Those
rules are set forth in OAR 952-001-0010 through OAR 952-001-0100 You may obtain copies of these rules or direct questions to OUNC at(503)
246-6699 or 1-800-332-23
Issued By: ��-- Permit Signature:,'en
OWNER INSTALLATION ONLY
The installation is being made on property I owr, which is not intended for stile, lease, or rent.
')WNER'S SIGNATURE: __- DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELECT': DATE:
LICENSE NO: --- -- --- -- -- -------- ------ -- -- -- -
Call 639-4175 by 7:00pnr `or an inspection the next business day
03/16/2004 14:49 503 616389 LEAR ELEC,rRIC CO INC PAGE 02
Electrical Perini! Anplicajoi
City of Tigarderrnii N
IROV,c""' �, ! ^
13125 SW Hall Blvd.,Ti OR 97223 ate/B : +
Plan--w
Phone: 503,639.4171 Fax: 503.598.1960 Dat"y: Other Permit:
Inspection Line: 503.639.417" [late Ready/By: v � turis: !a gee page 2 for
Internet: u•ww.ci.tigard or.ua NotiBcd/Method: _ 9rpplanenhl reformation
(I
❑New construction ®Addition/alteration/replacement Please check all that apply:
❑Demolition ❑Other: ❑Service over 225 amps,comr-1 [3Hazardous location
-7r,_1 ❑Service over 320 amps-rating ❑Buildng over 10,0D0 sq.ft.,
,�„ �P ]JC`l(;1171 I ;'!', . oft-and 2-family dwellings 4 or more new residential
❑ 1-and 2-family dwelling �;Commercial/industrial ❑Accessory Imilding E]System over r th volts nominal Feed in one structure
ElMulti-family ❑Master builder ❑Other: ❑Ilutlding over three stories ❑Feedtm,400 amps or more
❑Occupant load over 99 perso is ❑Manufactured structures or
'do I
[0*4�1t.(?CtAT [-JEgress/lighting plan RV park
Job no.:04-191 Job site address:9370 SW Greenburg Road,Ste.201 01ealth-care facility ❑Other:-
Submit 1_sets of plans with any of the above.
City/State/ZIP: The above are not applicable w temporary construction service.
Suite/bldg,/apt.no.: Project r:eme:Dr.Hayes ” iii' '; -' - "' 1, T. ..
_--� Description oly. Fee. I Tani
Cross street/directions to job site: New residential single-or multi-family dwelling unit.
Includes■tinched garage. _
_ l,(f,Dsq.fl.orless 145.15 4
Subdivision: - — Lot nn.: Ea.add'15(t0 sq.R.or portion 33,40 V
TAx map/parcel no.: I imited energy,residential 7S.00 2
Limited energy,non-residential 75.00 2
_ I)1i9Clil�TliJN' WOktZI` w' Each manufactured or modular
Branch Circuits dwelling,service end/or feeder 90.90 2
Services or feeders installation,alteration,and/or relocation
200 amps or less 80.302
►+p r 'i ;; I"I! " � ki7i r, 201 amps to 400 amps 106.85 2
401 amps to 600 amps! 160.60 2
Name:Dr.Hayes 601 amps to 1,000 ams 240.60 2
Address:9370 SW G•eenburg Road Over 1,000 amps or volts 454.65 2
--- Reconnect only 66.85 2
City/State/ZIP:Portland,OR Temporary services or feeders Installation,alteration,and/or
relocation
Phone:( ) Fax:( ) 200 amps or less _ 66.85 I
Owner Installation:This installation Is being made on property that I own which is not 201 am I It.400 amps 100.30 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 401 amps to 600 amps _ 133.75 2
Owner signature: Date: Bra.tch circuits-new,alteration,or extension,perQanel _
A.Fee for branch circuits with
service or feeder fee,each
13us1,.:ss name:See"Contractor" branch circuit 6.63 2
` �
13.Fame for branch circuits
Contest name: without service or feeder fee, i
`- each branch circuit 46'85 yV 2
Address: Each add'I branch circuit 6.65 < 2
City/State/ZIP: Miscellaneous(service or flbder not Included)
Pump or irrigation circle 53.40 2
Phone:( ) Fax::( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s)or limited-
----
T, 100 1tACTOtt energy panel,alteration,or
-- ---- extension.Describe: Page 2 2
Business name:Lear Electric Co.,Inc. _
Address: PO Box 573 - Eacb addltlorul Inspection over allowable in any of the above
__--_ - - Perin cion 6250
City/State/ZIP:Gresham,OR 97030 Investigation per hour(I hr min)- 62.50
Phone;(503)665-9840 Fel (503)661-6399 Industrial plant er hour 77.75
CCR 1 .r.: 52278 Electrical Lic.: 26-411(' I Suprv,Lie.: 371165 Subtotal .9D
Suprv.Electrician signature,required: Plan review(25%of permit fee)
Print nom,-:—DA f 1 �-O,Q ZZ,
Date: 3/151114 _ _ State surcharge(9%of permit fee)
� � _ TOTAL PERMIT FF
Authorize?signature: =r / 7h19 parmlt applicatler expires If a permit is net obtained within 11110
4--lil�4t`
a
days after It has been accepted complete
Print name.
Date:3_/s —0S/i—1 I Ftt nethndology act by Tri-County Building Industry Sen ire Board
••Nur bet of lection cr permit allowed.
I\Ruildlty\Pem0w%LC-PetmitAm dne 12/07 uD eRI5T110+'OLCOMr1t'ER W`
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CITYOF TIGARD R® _ MECHANICAL PERMIT
I /'1
DEVELOPMENT SERVICES PERMIT#: MEC2004-00144
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/24/04
PARCEL: 1 S126DB-02800
SITE ADDRESS: 09370 SW i,RcENBURG RD 201
SUBDIVISION: PP1991-01A ZONING: C-P
BLOCK: LOT: 001 JURISDICTION: TIG
r:LASS OF WuRK: ALT FLOOR FURN: EVAP COOLERS:
"TYPE OF USE: CONI UNIT HEATERS: VENT FANS:
OCCUPANCY GRP: VENTS W/O APPL: VENT SYSTEMS:
STORIES: BOILERS/COMPRESSORS _ HOODS:
F_UEL TYPES 0 3 HP: DOMES. INCIN:
- 15 HP: COMML. INCIN:
MAX INPUT: BTU 15 - 30 VIP: REPAIR UNITS-
FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES:
GAS PRESSURE: .J + HP: CLO DRYERS:
FURN < 100K BTU: AIR HANDLING UNITSOTHER UNITS:
FURN >=1nnK BTU: <= 10000 cfm:
GAS OUTLETS:
> 10000 cfIrr.
Remarks: Install exhaust fun m x-ray room ,(Io cltyli; 111 n0,nnI
Owner: _ _
`—_---- FE-ES
FRANKLIN COMMONS ASSOCIATES Description Date Amount
BY NORRIS + STEVENS IN1FUIII Permit FCC 3/24/04 $72.50
520 SW 6TH STE 400 1TA-X1 8115,Suile Surclwrl 3/24/04 $5.80
PORTLAND, OR 97204 _
Total $78.30
Ph ane:
Contractor:
INTEGRA SERVICE CO
201 S HARRISUN
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone: 503-j$4-171 d Final Inspection
Reg #: LIC 135441
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OrP. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-00
Issued By: c�!/Ye6394iTby7.0
Permittee Signature.Call (50 P.M. for inspections needed tha next business day
A 1A
r echanicaf Permit Ai)p[ication JORPFFICE USE ONLY
City Tigard of Ti d
Date/By: Pemut &,
13125 SW Hell Blvd.,Tigard,OR 97223 Plan P.aview uv.�
Phone: 503.639.4171 Fax: 503.598.1960 Other Permir n
Dale/By: fav O 2-
Internet: Line: 503.639r.us Cate Ready/By: lura ® gee Page 2 for
Internet www.ci.tigard Deus Notified/Method: Supplemental Information
�- T'. RE OF WORK COMMERCIAL FEE* SCHEDULE - USE CHECKLIST
❑New construction Addition/alteration/replacement Mechamca!permit fees'are based on the value of the work
performed.Indicate the value(rounded to the nearest dollar)of all
❑ Demolition 90ther: mechar. :al materials,equipment,labor,overhead,and profit.
CATEGORY OF CONSTRUCTION Value.$ 1
"-
❑ mil
I-and 2-fay dwelling f�Commercial/industrial ❑Accessory building RESIDENTIAL EQUIPMENT/SYSrEMS FEES"
❑ Multi-fancily (❑`Master builder El Other: For special information use checklist.
Description Qty Ea To,41
JOU SITE INFORMATION AND LOCATION Heating/cooling
Air conditioning or heat pump
Job site address: >
C r fit/ '�h f' C"/L [ '� (requires site Ian showing placement 14.00
City/State/ZIP: T;t� r� Furnace 100,000 BTU ducts/vents) 14.00
r Furnace 100,000+BTU(ducts/vents) 1790
Suite/bldg./apt.no.: � Proiect name: Gas heat pump 1400
Cross street/directions to job site: v - C Duct work 1400
n��QQ
_Lldronic hot waters stem 14.00
_TC�)9Z�4 Q J A L L4 Residential boiler(radiator or
h dronic) 14.00
--- Unit heaters(fuel-type,not electric),
in-wall,in-duct,suspended,etc 1000
Subdivision: Lot no.: Flue/vent for anyof above 10.00
--- ------_ -- - Other: 10.00
Tax trap/parcel no.: Other fuel appliances
DESCRIPTION OF WORK Water heater 10.00
—` -_-----" Gas fireplace 10.00
Y5rA �j _ kh/1L T /' �/ Ly Flue vent for water heater or gas
' \ fireplace 1000
-- X� �"'�- 4 ��'��"�^�°'T��'
Log li hies as 10.00
Wood/pellet stove 1000
— Wood fire lace/insert 10.00
❑ PROPERTY OWNER —�-- ❑ TENANT Chimney/liner/flue/vent 1000
--------- -- -� ------------ - Other 10.00
Name Environmental exhaust and ventilation
Address Range hood/other kitchen
equipment 1000
------- ---
City/StaterZlP. Clothes dryer exhaust 10.00
-- --- - --- -- --- Single-duct exhaust(bathrooms,
Phone-( ) Fax:( ) _- _ toilet cc Tt artments,utility rooms) 6.80
APPLICANT CONTACT PERSON Atticicrawis ace fans -- 10.00
— -- -- --- -- - -- ----. Other: 1000 r
Business name: -
-� Fuel piping
Contact name: d,Qe09 a r• �-- $5.40 for(int four;$1.00 for each additional
Address: e 1N,,�,iz,� , Furnace,etc.
S V's Gas heat pump
City/Slate/Z[P: --X/Cc (422 �� Wall/suspended unit heab r _
Phone:(y23 ) y. Fax: : ) fy(//. Water heater
F r lace
F:-mail
- Range
CONTRR C'UOR Barbecue
Business natne �.0 ------ -- --- Clothes dryer as
-- - - --- -- Other
Address:
11411thk OCAL PERMIT FEES*
City/State/ZtP: Subtotal
- --
Phone: Fax: Minimum permit fee($72 50) oZ.
( ) ( ) - I
Plan review(15%of permit fee)
CC13 lic.: State surcharge(8%of permit fee) ) ,
TOTAL PERMIT FEE
Authorized Signattt�ea"`--'—r. This permit application expires if a permit is not obtained within"O
days after it has been accepted as complete.
Print name: • Fee methodology set by Tri-County Building Industry Service Board
iiBudding\PermtsAPFC.PemutArpdoc 12103 410.4617T(I1,02/CONVWEB)
CITY OF TIG AR® 24-Hour
BUILriINO Insr ,tion Line: (503)639-4175
MST
INSPECTION 0I'VISION Business Line: (503) 639-4171
BL:P yam '
�.
Received 123 _Pnn Date Rey ested 3..-0 AM__ ___ PM _ BLIP —
Location Suite_ MEC
Contact Person _ Ph ( ) .•ZPLM
Contractor __ Ph ( _.) — _--_ SWR -_—
BUILDING Tenant/Owner ELC
Footing EL-C
Foundation Ac(xss.
Ftg Drain ELR - ---
Crawl Drain
Slab !nspection Notes: SIT
Post&Beam -- -
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing _-__._y-_.-. ---- ------ - ---- - --_ ---- .._
Insulation
Drywall Nailing -- - -- ----
Firewall /� F',-t' /L c�'�/�P C T✓t (c 4'
Fire Sprinkler - -Fire Alarm / �V Utj /4
Susp'd Ceiling - --
Roof
Ot - -
4SS -1
PART FAIL
NG -- —---
Post&Bear,
Under Slab -----
Rough-In
Water Service
Sanitary Sewer
Rair.Drains
Catch Basin/Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL __ ._
Post&Beam
Rough-In - - -- - --__
Gas Line
Smoke Dampers
Final
PASS PART FAIL_ --
I LECTRICAL
Service _ ~ --
Rough-In
UG/Slab
Low Voltage _
Fire Alarm
Final Reinspoction fee of$ required before next inspection. Pay at City Hall, 13126 SW Hall Blvd.
PASS--- PART FAIL
-------
SITE Please crdl for reinspection RE: -_�_— _ Unable to inspect-no access
Fire Supply Line
ADA Date_� �_�U v Inapertor Ext
Approach/Sidewalk - --
Other:
Final DO NOT REMOVE this Inspection record from the job site,
PASS PART FAIL.
1
/ C!T"'! OF T i r A R D CERTIFICATE OF OCCUPANCY
DEVELOPMENT SERVICES PERMIT#- BUP2004-00082
13125 SW Niall Blvd., Tigard, OR 97223 (503) 639-4171 HATE ISSUED: 3/3/2004
PARCEL: 1 S126DB-02800
ZONING: C-F
JURISDICTION: TIG
SITE ADDRESS: 09370 SW GREENBURG RD 201
SUBDIVISION: PP1991-018
BLOCK: LOT:001
CLASS OF WORK: ALT
TYPL OF USE: COM
TYPE OF CONSTR: 5N
OCCUPANCY GRP: B
OCCUPANCY LOAD: 9
TENANT NAME: DR HAYES
REMARKS: TI New wallc, for medical office.
Owner:
FRANKLIN COMMONS ASSOCIATES
BY NORRIS+ STEVENS
52u0 SW 6TH STREg47020
P Pone ND6�3-5704 04
Contractor:
ROBERT TODD CONSTRUCTION INC
4080 SE INTERNATIONAL WAY#D-1
MILWAUKIE, OR 97222
Phone: 653-5704
Reg#: LIC 98517
This Certificate issued 4/13/21110.1 grants occupancy of the above referenced
building or portion thereof and confirms that the building has been inspected for
compliance with the State of Oregon Specialty Codes for the group, occupancy,
and use fonder which the referenced permit wasA ue
4-t
HOLDING INSPECTOR BUILDING O'F ICIAL
POST IN CONSPICUOUS PLACE
CITYOF TIGA,RD _` PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004-00112
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 3/17/04
SITE ADDRESS: 09370 SW GREENBURG RD 201 PARCEL: 1S126DB-02800
SUBDIVISION: PP1991-018 ZONING: C-P
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREF,":T.�J;
OCCUPANCY GRP: B FLOOR DRAT";;,, TRAPS:
STORIES: WATER HEATERS: CATCH BASINS.
_ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUB/SHOWERS: SEWER LINE: ft
!NATER CLOSETS: WATER LINE ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI, other fixture is a primer.
_ FEES
Owner: iptlon Date Amount
FRANKLIN COMMONS ASSOCIATES 1, t IM131 Permit I�cc 3/17/04 $72.50
BY NORRIS + STEVENS
520 SW 6TH STE 400 [TA X l x°,,~lute 5urcharl 3/17/04 $5.80
PORTLAND, OR 97204 Total $78.30
Phone :
Contractor:
CASCADE PLUMBING CO.
2630 N HAYDEN ISLND DR. #503
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone : 503-544-746' Rough-in Inspi
Top-out ,nsp
Reg#: LIC 120893 Final Inspection
I'I.M +4-412113
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon ioN requires you to follow rules adopted by the Oregon
Issued - C.��� Perrottee Signature:��A
Cali(503)839-4175 b'/7:00 P.M. for an in.:pection needed the next business day
CITYOF TIGARD _ SEWER CONNECTION PERMIT
DEVELOPMENT SERviCES PERMIT#: SWR2004-00088
4 13125 SW I all Blvd., Tigard, OR 97223 (.503) 639-4171 DATE ISSUED: 3/17/04
SITE ADDRESS; 09370 SW GRFFNB(JRG RD 201 PARCEL: 1S126DB-02800
SUBDIVISION: PP1991-018 ZONING: C-P
BLOCK: LOT: iiiil JURISDICTION: TIG
TENANT NAME: DR HAYE:S
USA NO: FIXTURE UNITS: 2
CLAS'IS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INS1 ALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .1 EDU increa--
Owner: _ — -- v-- FEES
FRANKLIN COMMONS ASSOCIATES Description Date Amount
BY NORRIS + STEVENS
520 SW 6TH STE 400 1SWUSA]Swr Connect 3/17/04 $24000
PORTLAND,OR 97204 1SWUSA] Swr Connect 3/17/04 $0.00
Phone: Total $240.00
Contrac'or:
{,hone:
Reg #.
Required Inspections
�I
This Applicant .grees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so IOcated,the installer shall purchase a"Tap and Side Sewer" Perm
(ssued by: �� . Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next buslness day
Accumulative Sewer Tally Parcel# 1S126DB-02800
Tenant Name: Dr Hayas This SWRt 2004-000.1
Site Address: 9370 SW Greenburg Rd#201 This PLM# 2004-00112
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off#s count # _ value #s values
Ba tise /Font 4 0 0 0 0 0
Bath-Tub/Shower 4 0 0 0 0 0
-JacuzzlfWhiripool 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 _r 0 0 1 0 0
Ey 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 Drr 6 0 0 0 0 0
Garbage Dispr w _ _
-Domestic(to 3/4 HP) 16 0 0 __ 0 0 0
-Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 43 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
_Oil Sep(Gas Station) 6 0 0 1 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-Bar/Lavatory 2 0 0 1 2 1 2
_ Bradley 5 0 0 _ 0
_ Commercial 3 _ 0 0 0 _ 0 l
Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 1 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 3
Water Closet-Toilet 6 0 0 0 n 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 1 2 1 2
Current Fixture Value 2 divided by 16= 0.1 Current EDU 1 EDU _ $ 2,400
Previous Fixture Value_0 divided by 16= 0.0 Previous EDU
Change 2 divided by 16= 0.1 over (under) $ 240.00
Enter EDU Change Here 0.1
Notes:
SI ature date- D
Eluild g Division
Note: The property er shall reta!n the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
hich must be submitted to the City of Tigard Building Division to redeem credits towards future ystem development oharges.
I\Building\Sewer Tall y\SewerTallySheet.xls 11119/03