Permit CITY OF TIGARD SEWER CONNECTION PERMIT
az COMMUNITY DEVELOPMENT Permit#: SWR2013-00181
TIGARD 13125 SW Hall Blvd,Tigard OR 97223 503.718.2439 Date Issued: 09/17/2013
Parcel: 1 S 136DD05300
Jurisdiction: Tigard
Site address: 11850 SW 67TH AVE, STE#200
Project: Kronos Subdivision: WEST PORTLAND HEIGHTS Lot: 9
Project Description: .31 EDU increase
Contractor: Owner: PNWP LLC#2
PNWP LLC
6600 SW 105TH AVE#175
BEAVERTON,OR 97008
PHONE: PHONE.
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/17/2013 $1,488.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .31
Total $1,488 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 B • _ ' Permittee Signature:
Aft
Call 503.•4 ��y 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
C tenant Name: Kronor SWR# 2013-00181
TI GARD Site Address: 11850 SW 67th Ave#200 PLM# 2013-00304
Parcel#• 1S136DD05300
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 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
Nye Wash 1 0 0 0 0 0
Hoot Drain/Sink: -2 inch 2 0 0 0 0 0
-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 I IP) 32 0 0 0 0 0
-Industrial(over 5 111') 42 0 0 0 0 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 0 0 0 0
-Stall 2 0 0 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 0 1 2 1 2
-Bradley 5 0 0 0 0 0
-Com/Scrv/Uul-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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
'l'OT,U.S 0 0 0 0 3 5 3 5
Current Fixture Value 5 divided by 16= 0.313 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous 113U
Change 5 divided by 16= 0.313 over (under) S 1,488.00
Enter EDU Change Here _ 0 310
Notes:
Authorized Name/Signature: Debbie.\damski Date: 8/29/2013
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.
1\Building\Sewer Tally\Sewer I'allyShcct_4800._1170113 xlsx