Permit CITY OF TIGARD SEWER CONNECTION PERMIT
o �
.: COMMUNITY DEVELOPMENT ar4V '/ Permit#: SWR2013-00054
T i GAR O 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 1S 134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P-A
Project: FMC • Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: 3
Project Description: 4.05 EDU increase. 7/23/2013: Additional plumbing fixtures found during inspection were added which increased
the EDU to 4.68.
Contractor: Owner: FRESENIUS MEDICAL CARE, NA
5251 DTC PARKWAY
GREENWOD VILLAGE,CO 80111
PHONE: PHONE: 303-712-1814
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/26/2013 $21,832.20
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 4.68
•
Total $21,832.20
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 c.• • le rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2
Issued By: Permittee Signature
Call 503.63 •• .00 a.m.for the next availa.. _ •
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.
a Accumulative Sewer Tally
0 Tenant Name: FMC SWR# 2013-00054 REVISED
v Site Address: 10300 SW Nimbus,Tigard,OR 97223 PLM# 2013-00082
T I_��iAik}D
a Parcel#: 1 S134AA02100
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 1 4 0 -1 -4
-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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 4 8 4 8
-3 inch 5 0 0 3 15 3 15
-4 inch 6 0 0 4 24 4 24
-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 HP) 32 0 0 0 0 0
-Industrial(over 5 I-IP) 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 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 14 28 14 28
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 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 0 1 6 1 6
Urinal
•
6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.2 3.2
TOTALS 0 0 1 4 27 82 26 74.8
Current Fixture Value 74.8 divided by 16= 4.675 Current EDU 1 EDU= $4,665.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 74.8 divided by 16= 4.675 over (under) $ 21,832.20
Enter EDU Change Here 4.680
Notes: 3/14/13,CREDITS FROM PLM2011-00184 APPLIED TO THIS PERMIT,NO CREDITS REMAINING.Dra
REVISED 7/18/2013 from 4.05 to 4.68 EDU for additional fixtures.
Authorized Name/Signature: Dianna I-Iowse Date: 7/18/2013
•
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\Sewerl'allyShect-4665.xls 07/01/12
•
CITY OF TIGARD SEWER CONNECTION PERMIT
4, COMMUNITY DEVELOPMENT Permit #: SWR2013 -00054
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/26/2013
Parcel: 1 S134AA02100
Jurisdiction: Tigard
Site address: 10300 SW NIMBUS AVE P -A
Project: FMC Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 3
Project Description: 4.05 EDU increase
Contractor: Owner: FRESENIUS MEDICAL CARE, NA
5251 DTC PARKWAY
GREENWOD VILLAGE, CO 80111
PHONE: PHONE: 303 - 712 -1814
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/26/2013 $18,893.25
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 4.05
Total $18,893.25
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 he ules or : rec questions
to OUNC by calling 503.23 .1987 or 1.800.332.2344.
Issued By: Permittee Signature: i
Vir —
Call 503.639.4175 by 7:00 a.m. for the next available inspectio date.
This permit card shall be kept in a conspicuous place on the job site until co •letion • the project.
Approved plans are required on the job site at the time of each ins •ectio
Accumulative Sewer Tally Parcel # 1S134AA02100
T'cnant Name: Spec Space" ' CRIDIT'S"'3 /1 -1/13 Rl: \'ISI•:I) "' This SWR# N/A
Sitc Address: 10300 SW Ni P.\ This 1'1,\1# 2011 -00184
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total 5
count off #s count # value #s values •
Baptistry/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
i ::.)
Drinking Fountain 1 0 0 0 0 0
1 ?ve Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0 (1
flinch 6 0 0 0 0 0
PA
- Car Wash Drn 6 0 0 0 0 0 %
Garbage Disposal
k
- Domestic (to 3/4 11P) 16 0 0 0 0 0
o
- 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 f:
Oil Sep (Gas Station) 6 0 0 0 0 0 v
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
U4
Sink - Bar /Lavatory 2 0 0 0 0 0 i
- Bradley 5 0 0 0 0 0 O
- Commercial 3 0 0 0 0 0 Q
- Service 3 0 1 3 0 -1 -3
(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 [DU Count 0 0
Capped I ?DU Credit 0
'l'O'1', \I.,S 0 0 1 3 0 0 -1 _ -3
Current Fixture Value -3 divided by 16 = -0.2 Current I?DU 1 EDU = S 4,100
Previous Fixture Value 0 divided by 16 = 0.0 Previous I ?DU
Change - 3 divided by 16 = - 0.2 over (under) S (820.00)
Enter EDU Change Here - 0.2
Notes: ** *CREDIT'S ** *3/14/13, .2 CRI:,DIT'S APPI,II ?D TO S \W122013 00054, NO CREDITS RFiM \INING dra
Authorized Name /Signature: Debbie . \damski Date: 6/10/2011
Building Division
Note: The property owner shall retain the ORIGIN, \I, 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 \Sewer I'allySheet- 4100.xls 07/01/10