Permit CITY OF TIGARD SEWER CONNECTION PERMIT
N I C COMMUNITY DEVELOPMENT Permit #: SWR2013 -00151
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2013
Parcel: 1 S126DC80001
Jurisdiction: Tigard
Site address: 9385 SW LOCUST ST
Project: Family Practice Clinic Subdivision: LOCUST OFFICE PARK CONDO Lot: 1
Project Description: .28 EDU Increase. Note: EDU credits applied from PLM2009 -00357.
Contractor: Owner: TSE INVESTMENTS LLC
PO BOX 1754
LAKE OSWEGO, OR 97035
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/02/2013 $1,306.20
Type of Use: COM
Class of Work: ALT
install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .28
Total $1,306.20
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 copy of the rules or direct questions
to OUNC by calling 503.232 1987 or 1.800.332.2344.
Issued By: 503.232 Permittee Signature: o 4 /97 . (69 A-/
Call 503.639.4175 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.
I Accumulative Sewer Tally
p i T en ant Name: ' Family Practice Clinic SWR # 2013 -00151
rFgA'REI Site Address: 9385 SW Locust St. PLM # 2013 -00209
•
Parcel #:' 1 S126DC80001
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 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
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink: - 2 inch 2 0 1 2 0 -1 -2
- 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 1 -IP) 16 0 0 0 0 0
- Commercial (to 5 1-IP) 32 0 0 0 0 0
- Industrial (over 5 I -1P) 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 5 10 5 10
- Bradley 5 0 0 0 0 0
- Com /Sery /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 lI DU Count 0 0
Capped EDU Credit 0.6 9.6
TOTALS 0 0 1 2 6 16 5 _ 4.4
Current Fixture Value 4.4 divided by 16 = 0.275 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 4.4 divided by 16 = 0.275 over (under) $ 1,306.20
Enter EDU Change Here 0.280 1
Notes: Applied EDU credits from PLM2009- 00357.
Authorized Name /Signature: Dianna Howse Date: 1 06/27/2013
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 \Sewer I'allySheet- 4665.xls 07/01/12