Permit CITY OF TIGARD SEWER CONNECTION PERMIT
`'k'! 2 COMMUNITY DEVELOPMENT Permit #: SWR2011 -00105
T[GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/14/2011
Parcel: 2S 101 DC00200
Jurisdiction: Tigard
Site address: 13535 SW 72ND AVE 200
Project: Optilink Subdivision: 72ND AVE OFFICE BUILDING Lot:
Project Description: .4 EDU increase.
Contractor: Owner: PNWP LLC #2
BY PACIFIC NW PROP LTD PTNSP
PO BOX 2206
BEAVERTON, OR 97075
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/14/2011 $1,800.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units: 2
Number of Dwelling Units: .4
Total $1,800.00
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 503.232.1987 or 1.800.332.2344.
Issued By: ! Permittee Signature: - , /
Call 5: 0}175 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
P ILINK : = SWR # SWR2011 00105
.14,„ Tenant Name: O AVE SUITE 2 00, ,' t " PLM # PLM201.1. 00226 ,..
Site t \ddretis:.13535 SW 72ND
1:77.101 Parcel #: 251,01 DC00200 , , ' , ;;Y
Value Previous Previous Credits Capped Fixture Fixture New New
Fixture # value capped off value added added total total
count off #s count # value #s values
Baptisery /Font 4 :i T 0 _ -, 0 0 0 0
Bath - Tub /Shower 4 - 0 0 „ 0 0 0
— Jacuzzi /Whirlpool 4 Vi a.. 0 �i�' ' , 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 , r ` . r 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 i.•' ,a 0 = 0 0 0
- Car Wash Drn - 6 a ' ' 4'0:4 0 0 ., 0 0 0
Garbage Disposal
- Domestic (to 3/4 l-IP) 16 ; 0 0 0 0 0
- Commercial (to 5l -IP) 32 ,, 0 0 0 0 0
, '
- Industrial (over 5 1-11 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 r` 0 0 0 0
Oil Sep (Gas Station) 6 0 ' is t, ;. 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 - Bar /Lavatory 2 -, 0 11 7 P 0 i ” - 0 0 0
- Bradley 5 - 0 0 �r, 0 0 0
- Commercial 3 0 0 2 6 2 6
- Service 3 0 0 0 0 0 •
Swimming Pool Filter I . _` ' 0 0 .. 0 0 0
Washer - Clothes 6 `=1t ; `? - " 0 0 . . � `. 0 0 0
a
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 • f, 0
TO'T'ALS 0 0 0 0 2 6 2 6
Current Fixture Value 6 divided by 16 = 0.4 Current EDU 1 EDU = $4,500.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 6 divided by 16 = 0.4 over (under) $ 1,800.00
Enter EDU Change Here 0 :4'
Notes:
Authorized Name /Signature: B1ZANL.LN TAGGART�X449 ''' ""
, _ - , . Date: . . 7/.1;4/2011 . _ "' . .
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 \ScwerTallySheet- 4500.xls 07/01/11
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