Permit CITY OF TIGARD
rir SEWER CONNECTION PERMIT
t: COMMUNITY DEVELOPMENT Permit#: SWR2013 00204
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/09/2013
Parcel: 2S101AC00800
Jurisdiction: Tigard
Site address: 7148 SW GONZAGA ST
Project: The Adrienne Subdivision: BEVELAND NO.2 Lot: 14
Project Description: 5/29/2014: REPRINT permit to adjust EDU's from 9.75 to 9.88 EDU's for conversion of(1)residential unit on 2nd
floor to office space(7 EDU's for MF units and 2.88 EDU's for commercial area). 11/19/2014: REPRINT permit for
(1)dishwasher and(1)floor drain for a new total of 10.13 EDUs.
Contractor: Owner: ROGERS, ROY R
13690 SW TWELVE OAKS CT
TIGARD, OR 97224
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/10/2014 $47,424.00
Sewer Inspection-Commercial 12/09/2013 $45.00
Type of Use: COM Sewer Connection Fee 12/15/2014 $1,200.00
Class of Work: NEW
Install Type:
Fixture Units:
Number of Dwelling Units: 9.88
Total $48,669.00
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. Thos- - .re 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 b ailing 503.2 : 19: •r 1.800.332.2344.
Issue. By: I / �{( � Permittee Signature LyJ/
Y r fc r[
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 Tenant Name:The Adrienne SWR# 2013-00204_REV2
TI G A R D Site Address: 7148 SW Gonzaga St PLM# 2013-00420
Parcel#: 2S101AC00800
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
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 3 6 3 6
-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 HP) 16 0 0 0 0 0
-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
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 6 12 6 12
-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 4 24 4 24
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 15 50 15 _ 50
Current Fixture Value 50 divided by 16= 3.125 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 50 divided by 16= 3.125 over (under) $ 48,624.00
Enter EDU Change Here 10.130
Notes: REVISED: This building is a 3-story mixed use building. Lower level is office space and upper levels are(7)apartments plus(1)office space.
Residential apartments=7 EDU's,plus commercial=3.13 EDU's,for a total of 10.13 EDU's.
Authorized Name/Signature: Dianna Howse Date: 11/17/2014
Building Division
ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
r
I:\Building\Sewer Tally\SewerTallySheet_4800._070113.xlsx
IIII Accumulative Sewer Tally Tenant Name: The Adrienne SWR#20134Q204RBY1
I II Site Address: 7148 SW Gonzaga St PLM# 2013-00420
TIGARD Parcel#: 2S101AC00800
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 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 FIP) 16 0 0 0 0 0
-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
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 6 12 6 12
-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 4 24 4 24
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 13 46 13 _ 46
Current Fixture Value 46 divided by 16= 2.875 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 46 divided by 16= 2.875 over (under) $ 47,424.00
Enter EDU Change Here 9.880
Notes: REVISED: This building is a mixed use building,lower level is commercial,upper level are(7)apartments plus(1)commercial office.
Upper level(apts)=7 DU's+lower level 2.88 DU's=9.88 DU's for total fee of$47,424.00.
Authorized Name/Signature: Dianna Howse Date: 5/20/2014
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.
L:\Building\Sewer Tally\SewerTallySheet_4800._070113.xlsx
Accumulative Sewer Tally
• SWR# 13-00204 ,
II Tenant Name: The Adrienne '�
T I G A x u Site Address: 7148 SW Gonzaga St PLM# 2013-00420
Parcel#: 2S101AC00800
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 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 I-IP) 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 3 6 3 6
-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 2 12 2 12
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 _ 0 0 8 28 8 _ 28
Current Fixture Value 28 divided by 16= 1.750 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 28 divided by 16= 1.750 over (under) $ 46,800.00
Enter EDU Change Here 9.750
Notes: This building is a mixed use building,lower level is commercial,upper level are(8)apartments.
Upper level(apts) =8 DU's+lower level 1.75 DU's=9.75 DU's for total fee of$46,800.
Authorized Name/Signature: Debbie Adamski Date: 11/26/2013
Building Division
r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
l:\Building\sewer Tally\SewerTallySheet_4800._070113.xlsx
•CITY OF TIGARD t SEWER CONNECTION PERMIT
311 ; .I. COMMUNITY DEVELOPMENT ®Z4 n, Permit#: SWR2013-00204
Date Issued: 12/09/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 09/201 0800
Jurisdiction: Tigard
Site address: 7148 SW GONZAGA ST
Project: The Adrienne Subdivision: BEVELAND NO.2 Lot: 14
Project Description: 5/29/2014: REPRINT permit to adjust EDU's from 9.75 to 9.88 EDU's for conversion of(1)residential unit on 2nd
floor to office space(7 EDU's for MF units and 2.88 EDU's for commercial area).
Contractor: Owner: ROGERS, ROY R
13690 SW TWELVE OAKS CT
TIGARD, OR 97224
PHONE
PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/10/2014 $47,424.00
Sewer Inspection-Commercial 12/09/2013 $45.00
Type of Use: COM
Class of Work: NEW
Install Type:
Fixture Units:
Number of Dwelling Units: 9.88
Total $47,469.00
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 503.232.1 8Z.or 1.800 32.2344.
Issued By: / r / -C•"-{•.�� Permittee Signature: Al MP�G T/o
`��v 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.
Ili Tenant Name: The Adrienne Accumulative Sewer Tally SWR# 2013-00204 REVISED
i i r i Site Address: 7148 SW Gonzaga St PLM# 2013-00420
Parcel#: 2S101AC00800
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 11 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 HP) 16 0 0 0 0 0
-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
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.Vehicle Dump station 16 0 (1 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 6 12 6 12
-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 4 24 4 24
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 _ 0 0 0 13 46 13 46
Current Fixture Value 46 divided by 16= 2.875 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 46 divided by 16= 2.875 over (under) $ 47,424.00
Enter EDU Change Here 9.880
Notes: REVISED: This building is a mixed use building,lower level is commercial,upper level are(7)apartments plus(1)commercial office.
Upper level(apts)=7 DU's+lower level 2.88 DU's=9.88 DU's for total fee of$47,424.00.
Authorized Name/Signature: Dianna Howse Date: 5/20/2014
Building Division
ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
r
I:\Building\Sewer Tally\SewerTallySheet_4800._070113.xlsx
CITY OF TIGARD t SEWER CONNECTION PERMIT
' Q COMMUNITY DEVELOPMENT t Permit#: SWR2013 00204
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 v� Date Issued: 12/09/2013
Parcel: 2S 101 AC00800
Jurisdiction: Tigard
Site address: 7148 SW GONZAGA ST
Project: The Adrienne Subdivision: BEVELAND NO.2 Lot: 14
Project Description: 9.75 EDU's(8 EDU's for MF units and 1.75 EDU's for commercial area) 1/6/14,reprinted to add ASI info
Contractor: Owner: ROGERS, ROY R
13690 SW TWELVE OAKS CT
TIGARD,OR 97224
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Inspection-Commercial 12/09/2013 $45.00
Sewer Connection Fee 12/09/2013 $46,800.00
Type of Use: COM
Class of Work: NEW
Install Type:
Fixture Units:
Number of Dwelling Units: 9.75
Total $46,845.00
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 . - - 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 =ling 503.232. r 1.800.332.2344.
Issued ;:y: / `� ,L 4 1 , Permittee Signa
Call 503.639.4175 by 7:00 a.m.for the next available inspectio e.
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.
•
CITY OF TIGARD SEWER CONNECTION PERMIT
' .. H. COMMUNITY DEVELOPMENT Permit #: SWR2013 -00204
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/09/2013
Parcel: 2S 101 AC00800
Jurisdiction: Tigard
Site address: 7148 SW GONZAGA ST
Project: The Adrienne Subdivision: BEVELAND NO 2 Lot: 14
Project Description: 9 75 EDU's (8 EDU's for MF units and 1.75 EDU's for commercial area)
Contractor: Owner: ROGERS, ROY R
13690 SW TWELVE OAKS CT
TIGARD, OR 97224
•
PHONE PHONE
FAX.
FEES
• Description Date Amount
Specifics: Sewer Inspection - Commercial 12/09/2013 $45 00
Sewer Connection Fee 12/09/2013 $46,800 00
Type of Use: •
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $46,845 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 sus•en.ed for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. ose rules 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 OU» »C by calling 503 23' 1987. 1.800.332.2344. �D o
Is.uedBy: 4 011,4 `/ Permittee Signature: r��% /� /"___
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.
' a Accumulative Sewer Tally
1 1111 0 'Tenant N ame. The Adrienne SWR # 2013 -00204
TIGARD Site Address. 7148 SW Gonzaga St PI_M # 2013 -00420
Parcel # 2S101AC00800
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 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 1 -lP) 16 0 0 0 0 0
- Commercial (to 5 RP) 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
- l,av /Bar - Non -Food Related 2 0 0 3 6 3 6
- 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 2 12 2 12
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
'10'1A1,S 0 0 0 0 8 _ 28 8 28
Current Fixture Value 28 divided by 16 = 1.750 Current EDU 1 EDU = $4,800.00
Previous Fixture Value 0 divided by 16 = 0000 Previous IiDU
Change 28 divided by 16 = 1.750 over (under) S 46,800 00
Enter EDU Change Here 9.750
Notes This building is a mixed use building, lower level is commercial, upper level are (8) apartments
Upper level (apts) = 8 DU's + lower level 1 75 DU's = 9.75 DU's for total fee of S46,800.
Authorized Name /Signature: Debbie Adamski Date: 11/26/2013
Building Division
Note: The property owner shall retain the ORIGINA1, 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 ASe vcr'I'ailyShect_48U(I _070113 xlsx