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Permit n CITY OF TIGARD SEWER CONNECTION PERMIT ' - COMMUNITY DEVELOPMENT Permit : SWR2010-00126 Date Issued: 09/24/2010 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 120 Subdivision: Lot: 0 Project: Property Management Office Project Description: .1 EDU increase. FEES Owner: Description Date Amount G &S FC LLC 16850 SW UPPER BOONES FERRY RD STE A Sewer Connection Fee 09/23/2010 $410.00 PORTLAND, OR 97224 PHONE: 503 -639 -0108 Contractor: PHONE: FAX: Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .1 Total $410.00 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: Permittee Signature: en/ /9-10,6 / C 9 77t v/ CaII 503.639.4175 by 7:00 a.m. for an Inspection that business day. 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 Parcel # 2S113AB00500 • Tenant Name: SPEC SPACE This SWR# SWR2010 - 00126 Site Address: 16083 SW UPPER BOONES FERRY RD, STE 120 This PLM# PLM2010 - 00310 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 Baptiscry/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 1 0 0 0 0 Cuspidor /Water Aspirator 1 0 I 0 0 0 0 Dishwasher - Commercial 4 0 I 0 0 0 0 - Domestic 2 0 I 0 0 0 0 Drinking Fountain 1 0 I 0 0 0 0 Eyc Wash 1 0 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 0 0 0 0 -3inch 5 0 0 0 0 0 - 4 inch 6 0 i 0 0 0 0 - Car Wash Dm 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 i 0 0 0 0 - Industrial (over 5 1-IP) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 i 0 0 0 0 Rec. Vehicle Dump station 16 0 j 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 I 0 0 0 0 - Commercial 3 0 I 0 0 0 0 - Service 3 0 0 0 0 0 Swimming Pool Filter 1 0 i 0 0 0 0 Washer - Clothes 6 0 i 0 0 0 0 Waterl 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 '1'O'1'AI S 0 0 0 0 1 2 1 2 Current Fixture Value 2 divided by 16 = 0.1 I Current EDU 1 EDU = $ 4,100 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 2 divided by 16 = 0.1 over (under) $ 410.00 Enter EDU Change Here 0.1 Notes: REVISED 9/23/2010 Authorized Name /Signature: Dianna Howse i Date:. 9/23/2010 Building Division s ote: The property owner shall retain the ORIGINAL sewer tally record. 1 f credits exist, this document will serve as a voucher which must be ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges. I: \ Building \Sewer Tally \Sewer 1'allySheet- 36011.xls 06 /25/08