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Permit CITY OF TIGARD SEWER CONNECTION PERMIT 11 ' COMMUNITY DEVELOPMENT Permit#: SWR2018-00102 T t 0.ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/19/2018 Parcel: 2S113AB00600 Jurisdiction: Tigard Site address: 16160 SW UPPER BOONES FERRY RD Project: Phytelligence Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30 Project Description: 1.38 EDU Increase Contractor: Owner: PACIFIC REALTY ASSOCIATES LP ATTN: N PIVEN 15350 SE SEQUOIA PKWY#300 PORTLAND, OR 97224 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 04/19/2018 $7,590.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 1.38 Total $7,590.00 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 calling 50332.1987 or 1.800.332.2344. Issued By: r Permittee Signature: A/ 1%-)L/f 47-/C;,,./ 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 41 C Tenant Name: Phytelligence SWR# 2018-00102 TI G n K D Site Address: 16160 SW Upper Boones Ferry Rd PLM# 2018-00172 Parcel#: 2S 113AB00600 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: -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 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 0 3 15 3 15 -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 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 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: -Lav/Bar-Non-Food Related 2 0 0 5 10 5 10 -Bradley 5 0 0 0 0 0 -Com/Sere/Util-Food Related 3 0 1 3 0 -1 -3 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 EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 3 8 25 7 22 Current Fixture Value 22 divided by 16= 1.375 Current EDU 1 EDU= $5,500.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 22 divided by 16= 1.375 over (under) $ 7,590.00 Enter EDU Change Here 1.380 * *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: Dianna Howse Date: 4/19/2018 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\SewerTallySheet_5500_070117.xlsx III TIGARD City of Tigard August 9, 2018 Pacific Realty Associates LP Attn: Leslie Louis 15350 SE Sequoia Pkwy, #300 Tigard, OR 97224 Re: Permit No. SWR2018-00102 Dear Applicant: The City of Tigard has processed a refund for overpayment of permit fees on the above referenced permit for the following: Site Address: 16160 SW Upper Boones Ferry Rd Project Name: Phytelligence Job No.: N/A Refund: ® Check#229412 in the amount of$3,135.00. ❑ Credit card"return" receipt in the amount of$ . ❑ Trust account"deposit"receipt in the amount of$ . Notes: Change in plumbing scope of work resulted in a reduction of sanitary sewer system development fees. If you have any questions please contact me at 503.718.2430. Sincerely, iii .....Ar„,,, Dianna Howse Building Division Services Coordinator Enc. I:\Building\Refunds\1Hfnifii5Nork\taefiibr-4ve a�.igMIOfegon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard-or.gov lh mi City of Tigard TIGARD Accela Refund Request This form is used for refund requests of land use, development engineering and building permit application fees. Receipts, documentation and the Request for Permit Action form (if applicable) must be attached to this request form. Refund requests are due to Accela System Administrator by each Wednesday at 5:00 PM. Please allow up to 3 weeks for processing of refunds. Accounts Payable will route refund checks to Accela System Administrator for distribution to applicant. PAYABLE TO: Pacific Realty Associates LP DATE: 8/3/2018 15350 SE Seqoia Pkwy, #300 Portland, OR 97224 REQUESTED BY: Dianna Howse TRANSACTION INFORMATION: Receipt#: 416857 Case#: SWR2018-00102 Date: 4/19/2018 Address/Parcel: 16160 SW Upper Boones Ferry Pay Method: CreditCard Project Name: Phytelligence EXPLANATION: Change in plumbing scope of work reduced sanitary sewer system development fees. Refund 100% of difference. - R ® ee� to s + r ; ` A' m , ,2 ,' ca, s . as 1 v , "` � r c a Sewer Connection Fee 500-0000-25500 $3,135.00 TOTAL REFUND: $3,135.00 APPROVALS: SIGNAT : S DATE: If under$5,000 Professional Staff : j If under$12,500 Division Manager If under$25,500 Department Manager If under$50,000 City Manager If over$50,000 Local Contract Review Board Case Refund Processed: Date: 4, S /7 By: j 1 ei� I:\Building\Refunds\RefundRequest.doc x 09/01/2010 • • 1111 Tenant Name: Phytelligence Accumulative Sewer Tally SWR#2018-00102 REVISED TI c;n K D Site Address: 16160 SW Upper Boones Ferry Rd PLM#2018-00172 Parcel#: 2S 1 13AB00600 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: -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 0 0 0 Eye Wash 1 0 0 2 2 2 2 Floor Drain/Sink: -2 inch 2 0 0 1 2 1 2 -3inch 5 0 0 0 0 0 -4inch 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 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 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: -Lay/Bar-Non-Food Related 2 0 0 6 12 6 12 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 1 3 0 4 -3 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 EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 3 9 16 8 13 Current Fixture Value 13 divided by 16= 0.813 Current EDU 1 EDU= $5,500.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 13 divided by 16= 0.813 over (under) $ 4,455.00 Enter EDU Change Here 0.810 * *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: 6/21/18 REVISIONS ADDED BY BRANDEN TAGGART:(2)EYEWASHES,(1)2"FLOOR DRAIN,(0)3"FLOOR DRAINS,AND(1) ADDITIONAL LAVATORY. Authorized Name/Signature: Dianna Howse Date: 4/19/2018 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\SewerTallySheet 5500_070117.xlsx Accumulative Sewer Tally 11 i Tenant Name: Phytelligence SWR#2018-00102 r/tle ✓4t L Site Address: 16160 SW Upper Boones Ferry Rd PLM#2018-00172 1IGARD Parcel#: 2S 113AB00600 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: -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 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 0 3 - 15 3 15 -4inch 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 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 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: -Lay/Bar-Non-Food Related 2 0 0 5 10 5 10 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 1 3 0 -1 -3 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 EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 1 3 8 25 7 22 Current Fixture Value 22 divided by 16= 1.375 Current EDU 1 EDU= $5,500.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 22 divided by 16= 1.375 over (under) $ 7,590.00 Enter EDU Change Here 1.380 * *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: Dianna Howse Date: 4/19/2018 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\SewerTallySheet_5500_070117.xlsx PLM2018-00172 16160 SW Upper Boones Ferry Rd Original Change Scope Qty Paid Qty Fees Sewer Cap 2 $ 50.04 1 $ 25.02 Sinks 6 $ 150.12 7 $ 175.14 Floor Drain 1 $ 25.02 1 $ 25.02 Primer 3 $ 37.53 3 $ 37.53 Eye Wash 2 $ 50.04 2 $ 50.04 Sub-total: 14 $ 312.75 14 $ 312.75 12%surcharge $ 40.53 $ 40.53 Total: $ 353.28 $ 353.28 s No refund processed as change in scope of work resulted in the same total of fees. /AY-- /`A Lf `/.SS , 0-0 /J t Li; cr 3/3 , 0-0 ,e-- zcntb ---r- 61-77 7/` z_95 L,/ &"--- 7C 5 5"0 -c 60 S4,- .e- o •9- Amp 443cre /9e -ze 7:6 072_ 77 ,2.y Se 1-/\/ c<., / / t`f .• CITY OF TIGARD S Z_. .rte_C.D/0 RECEIPT 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 TEGA.R.O Project Name: Phytelligence O170 y' 4t ok,,Z.) eAl ,i ci ri.6/..,6- Site Address: 16160 SW UPPER BOONES FERRY RD "� NE; , j ec P _ --C-0.741E � 5 r Receipt Number: 416862 - 04/19/2018 ��ef- < CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2018-00172 Fixture/Sewer Cap 230-0000-43101 $50.04 PLM2018-00172 Sink 230-0000-43101 $150.12 PLM2018-00172 12% State Surcharge-Plumbing 100-0000-24001 $37.53 PLM2018-00172 Floor Drain/Floor Sink/Hub 230-0000-43101 $25.02 PLM2018-00172 Primer 230-0000-43101 $34.53 PLM2018-00172 Misc Other Fee 230-0000-43101 $50.04 PLM2018-00172 12% State Surcharge-Plumbing 100-0000-24001 $3.00 Total: $350.28 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 04831D PUBLICUSERO 04/19/2018 $350.28 Payor: Corey J Chamberlain Total Payments: $350.28 Balance Due: $0.00 Page 1 of 1 71CITY OF TIGARD RECEIPT a ` . 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 ell—Ar TGCn;'�ifi'f � LGA / 77/ Project Name: Phytelligence C�l `—� 7 --60/0 Site Address: 16160 SW UPPER BOONES FERRY RD Receipt Number: 417958 - 06/21/2018 CASE NO. FEE DESCRIPTION REVENUE ACCOUNT NUMBER PAID PLM2018-00172 Primer el kl_•:/'4J'r/` elk. "c?/2 %/V t /Zr26 c j 230-0000-43101 $3.00 PLM2018 00172 Lavatories -m r4.r r t4„,t-t-e `"r e. 230-0000-43101 $25.02 Total: $28.02 .3 /6/2:A4 c71- Vit' /.z .S / .: 3 7•S3 Cc 1-i..E"CTrA -g v.S 3 I 3 :a ....7- _ 3 7. S.3 PAYMENT METHOD CHECK# CC AUTH.CODE ACCT ID CASHIER ID RECEIPT DATE RECEIPT AMT Credit Card 05779D DHOWSE 06/21/2018 $28.02 Payor: Corey Chamberlain,Always Faithful Plumbing LLC Total Payments: $28.02 Balance Due: $0.00 Page 1 of 1