Permit CITY OF TIGARD SEWER CONNECTION PERMIT
11 1 I COMMUNITY DEVELOPMENT Permit #: SWR2013 -00051
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/21/2013
Parcel: 2S102AC01100
Jurisdiction: Tigard
Site address: 12564 SW MAIN ST 100
Project: Spec Space Subdivision: BURNHAM TRACT Lot: 1
Project Description: 1.69 EDU increase
Contractor: Owner: MAIN STREET LLC &
DUDUNAKIS, MICHAEL P
18380 RIVER EDGE LN
LAKE OSWEGO, OR 97034
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/21/2013 $7,883.85
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 2.56
Total $7,883.85
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 suspe• • . or more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. ose rules • e set fo in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUN • by calling 503.2 .19 or .8 .332.2344.
Issu d By: / 4 ._ 7 4/ Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
Y P
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
Tenant Name: Spec Space SWR # 2013 -00051
TIGARD Site Address: 12564 SW Main St PLM # 2013 -00077
Parcel #: 2S1 02AC01100
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: -'l'ub /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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 0 2 4 2 4
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 I IP) 16 0 0 0 0 0
- Commercial (to 5 1 -1P) 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
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 1 2 1 2
Sink:
- Lav /Bar - Non -Food Related 2 0 0 3 6 3 6
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 3 0 0 1 3 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 4 24 4 24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.87 13.92
TOTALS 0 0 0 0 12 41 12 27.08
Current Fixture Value 27.08 divided by 16 = 1.693 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 27.08 divided by 16 = 1.693 over (under) S 7,883.85
Enter EDU Change Here 1.690
Notes: 3/13/13, capping of fixtures in upper stony (if building done without permit. Mark VanDomelen, allowed contractor to do fixture walk -thru of
entire building. Fixture count =1.13. UB is billing 2 F"DU's. We will be applying the difference as a capped credit to this permit. Walk-thru to be verified at inspectic
Authorized Name /Signature: Debbie . \damski Date: 3/11/2013
Building Division
( N ote: The property owner shall retain the ORIGINAL sewer tally record. I f 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.
1: \Building \ Sewer "rally \Sewer I'allyShcct- 4665.xls 07/01/12
604 L f 6f 2-u -�c-y
11 1 1 _ Tenant Name: Accumulative Sewer Tally - ti \\ It #
Site : \JJress: � 54 ./ � D /IA i ` d � j t` j � 1'I.\I # AC17av, J DOd z 7
TIGARD
Parcel #: 1 gj • &' tu. l.,t? /7.510 '/, /.�.5(ote °L / Z
Fixture Value Previous 4revious Credits Ca ‘ fixture '� Fixture New New
# value count capped #s value count ad`1e�i # 1 added value total #s total values
Raptiscry /I 4 0 0 P 1 1C 0 0
Bath: - Tub /Shower 4 0 0 ,iO Gv�1� 0� 0 0 0
Jacuzzi / \C hirlpool 4 0 0 ,`Q�N 0 0 0
Car Wash: - Uach Stall 6 0 0 0 COY
- Drive through 16 0 0 0 ♦ 11 1 /4 0
Cuspidor/Water A spirator 1 0 0 0 0- 0
CDiaiwaslicr: - Commercial 4 0 0 0 0 0
�I)omestic i 2 0 0 0 0 0
1.-
1 .D inking Fountainf / 0 0 0 0 0
I \Vash 1 0 0 0 0 _ 0
C l loot- Drain /Sink: - - - 2 - inch -7 ) 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car \Vash 6 0 0 0 0 0
Garbage Disposal:
- Domestic (to 3/4 I -IP) 16 0 0 0 0 0
- Commercial (to 5 Hl') 32 0 0 0 0 0
- Industrial (over 5 I -1P) 42 0 0 0 0 0
Ice \lachine /Refrigerator Drain 1 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
Sh 3WCF\ - Gang (per head) 1 0 0 0 0 0
,-- ', 2 0 0 0 0 0
Sink: 'j '------
(- l.ay /Bar - Nun -Food Related 2 UP3 0 (e 0 0 0 0
- Bradley 5 0 0 0 0 0
- Com/Serv/Util - Food Related 3 0 0 0 0
Swimming Pool Filter 1 0 �, 0 0 0
\Washer - Clothed' 6 0 1 7 1T 0 0 0
Water t {xtractor 6 0 C O l 0 0 0
\Cater Closet - 'toilet 6 4;.• '� 0 / �-- 8,4\ + � � 0 0 0
Urinal 7 6 0 _/ 0 0 0 0
Previous I�:DU Count 0 0
Capped [DU Credit (V 0
10 I .S 0 0 0 0 0 0 0 0
Current Fixture Value 0 is divided by 16 = 1. /3 0.000 Current I_•:DU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous [DU
Change 0 divided by 16 = 0.000 over (under) S -
Enter EDU Change Here 6E6$- /• /3
Notes: -- L41 LA AA __, Lt,. 1 . - 4.4 ! _ _ .�_ . 1I •
r-
O-TC u - 4 . L h t a., A . ' b (n.6 , , 3 " 1 3 ' 1 1 3 l
Authorized Name /Signature: Date: t//6 /6 f
Building Division 111
Note: The property owner shall retain the ORIGINAL, sewer tally record. I f 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 \Scwcr Tally \Scwcr'tallcShcct- 46G5.xls 07/01/12 -...c S3 y���� AJZQ,Q, Lt.) L ,3 4.
L eA&A?sc D 45, 2 \ Ea 5 . a EDI..2s -- fiu . Q - JJ.Qt...Q...0 (r. /3 Z . 87 �1,142s
. $7 `[tJi..k.t5 47 Lk_ ° m *. :1),D t Pal ao / 3 —eoa77 - i2. At,/ 3- eo451 0...0 eo. -�-� •
tf1J-4 , t . _S - 01 1,1-1,1L., \J • ` -L �I'— k - - r bbl... �-eA 0 L 0-----'.