Permit CITY OF TIGARD SEWER CONNECTION PERMIT
e COMMUNITY DEVELOPMENT Permit#: SWR2013-00186
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/30/2013
Parcel: 1S 135AB04500
Jurisdiction: Tigard
Site address: 10250 SW GREENBURG RD 110
Project: Family Health Subdivision: 1991-055 PARTITION PLAT Lot: 1
Project Description: .38 EDU increase
Contractor: Owner: LINCOLN CENTER LLC
BY SHORENSTEIN PROPERTIES LLC
555 CALIFORNIA ST 49TH FL
SAN FRANCISCO,CA 94104
PHONE: PHONE:
FAX:
- - -FEES- - - -
Description Date Amount
•
Specifics: Sewer Connection Fee 09/30/2013 $1,824.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .38
Total $1,824.00
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 rule - e 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 cal'-• 503.232. •87 o . .332.2344.
Issued B . , Permittee Sign u� re: /l
/L Aor Call 503.639.4175 by 7:00 a.m.for the next available inspecti•• •ate.
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
IIv
p Tenant Name: Family I lealth SWR# 2013-00186
TIGARD Site Address: 10250 SW Grcenburg Rd#110 PI,M # 2013-00327
Parcel#: 1S135AB04500
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#5 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: -IEach 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
Eve 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
-4 inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 I-1P) 16 0 0 0 0 0
-Commercial (to 5 I-1P) 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 1 2 1 2 0 0
-Bradley 5 0 0 0 0 0
-Cum/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 EDU Count 0 0
Capped EDU Credit 0
'1'O'1':U.S 0 0 1 2 2 _ 8 1 6
Current Fixture Value 6 divided by 16= 0.375 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous lil)U
Change 6 divided by 16= 0.375 over (under) S 1,824.00
Enter EDU Change Here 0.380
Notes:
Authorized Name/Signature: Debbie Adamski Date: 9/17/2013
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'allySheer_48IN1._117111 13.xlsx