Permit C ITY OF T I G A R D SEWER CONNECTION PERMIT
', ik DEVELOPMENT SERVICES PERMIT #: SWR2005 -00282
'� 13125 SW Ha Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/14/2005
PARCEL: 1S135AB-00900
SITE ADDRESS: 10200 SW GREENBURG RD 400 ZONING: C -P
SUBDIVISION: LINCOLN CENTER/FIVE LINCOLN LOT: JURISDICTION: TIG
Project Description: .4 EDU increase
TENANT NAME: NORPAC
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ADD DWELLING UNITS: 0.4
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
EQUITY OFFICE PROPERTIES TRUST
ONE SW COLUMBIA ST #300 Description Date Amount
PORTLAND, OR 97258 [SWUSA] Sewer Connection Fee 9/14/2005 $1,040.00
Total $1,040.00
Phone:
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
Reg #:
This Applicant agrees 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 located, the installer shall purchase a "Tap and Side Sewer"
Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the
Ore.: Iti rty • cation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You
m • y obtain copies o these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
O
Is ed by: /.t Permittee Sig nature: k- �9 � -- -�,�
Call 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 # 1S135AB -00900
Tenant Name: Norpac
LM
Site Adc#ress: 10200 SW Greenburg Rd #400, #500 & #600 This #2005 -00427
This PLM# 2005 -00427
Fixture Value Previous Previous Credits Capped Fixture Fixture
New New
# value capped off value added added total total
count off #s count # value
Baptisery/Font 4 #s va
0 0 0
Bath - Tub /Shower 0 0
4 0 0 0
- Jacuzzi /Whirlpool 4 0 0
0 0 0 0 0
Car Wash - Each Stall 6 0
0 0 0 0
- Drive through 16 0 0
Cuspidor /Water Aspirator 1 0 0 0
0 0 0 0
Dishwasher - Commercial 4 0
0 0
- Domestic 2 0 0 0 0 2 4 2 4 4 0
Drinking Fountain 1 0
Eye Wash 1 0 0 0 0 0
0 0 0 0
Floor Drain /Sink - 2 inch 2 0 1
2 2 4 1 2
- 3 inch 5 0
- 4 inch 6 0 0 0 0 0
0 0 0 0
- Car Wash Drr 6 0 0
Garbage Disposal 0 0 0
- 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 1 1 1 0
Ice Machine /Refrigerator Drain 1 0 0 1 1 1 1
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
-Stall 2 0 0 0 0 0
0 0 0 0
Sink - Bar /Lavatory 2 0 2 4
- Bradley 5 0 0 0 2 0 0 0
0 0
- Commercial 3 0
- Service 3 0 0 0 0 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
Urinal 6 0 0 0 0 0
0 0 0 0
Previous EDU Count 0
Capped EDU Credit 0
TOTALS 0 0 0
3 6 7 13 4 7
Current Fixture Value 7 divided by 16 = 0.4 Current EDU
Previous Fixture Value 0 divided by 16 = 1 EDU = $ 2,600
Y 0.0 Previous EDU
Change 7 divided by 16 = 0.4 over (under) $ 1,040.00
Enter EDU Change Here 0.4
Notes:
l Authorized Name /Signature: Debbie Adrrts / -�
-, ! fi.�'�u - LI Date: 9/9/2005
Bui •. -• Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
livhich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
: \Building \Sewer Tally \SewerTallySheet.xls 7/1/05