Permit CITY OF TIGARD SEWER CONNECTION PERMIT
S • COMMUNITY DEVELOPMENT Permittt: SWR2014-00003
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/16/2014
Parcel: 1 S126BC01506
Jurisdiction: TIGARD
Site address: 9020 SW WASHINGTON SQUARE RD 250
Project: LoanStar Home Lending Subdivision: CONDO,THE SUPPLEMENTAL PLAT Lot: 25-4
Project Description: .38 EDU increase
Contractor Owner: WISCO REAL ESTATE EQUITY FUND I
1501 SW TAYLOR ST STE 100
PORTLAND. OR 97205
PHONE: PHONE
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/16/2014 $1,824.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units
Number of Dwelling Units: .38
Total 51.824 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 it
work is sus.•++•. for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. hose ruleSThatesset 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 503.232. .•• or • :40.332 2344. -
Is•ued By: 1+ . / Permittee Signature:
;el"—Yi U�_�r
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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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
"Tenant Name: LoanStar Lending S\'r'R# 2014-00003
. I Site.Address: 9020 SW 1\'adhington Square Rd#250 PLM1# 2014-00012
Parcel#: 1 S 136CA09800
Fixture Value Irevious Preview. I:reins Capped Fixture Fixture New New
vahu c<,un! ∎hl,ccl ft. .,tine count .ulded t4 idded i.ilur total' total values
Baptisery/hunt 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
-Domestic 2 0 0 1 2 1 2
Drinking Fountain 1 0 0 0 0 0
Eve Wash 1 0 0 0 0 0
Floor Drain/Sink -2 inch 2 0 11 1 2 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 HP) 16 0 0 0 0 0
-Commercial(to 51-IP) 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
Living U nit 16 0 0 0 0 0
Oil Sep(Gas Station) 6 0 0 0 0 0
Rec.1'ehicle Dump station 16 0 0 0 0 0
Shower: -Gang(per head) 1 0 11 0 0 0
-Stall 2 0 1) 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 0 1 2 1 2
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 0 0 0
Swimming Pool Filter 1 0 'I 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Itxtractor 6 0 0 0 0 0
Water Closet-Toiler r 0 lI 0 0 0
Urinal i; 0 i 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TCYTAI S 0 0 0 0 3 6 3 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 EDU
Change 6 divided by 16= 0.375 over (under) $ 1,824.00
Enter EDU Change Here 0.380
Notes:
Authorized Name/Signature: Debbie. datnski Date: 1/15/2014
Building Division
ote: The property owner shall retain the ORIGIN Al.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.
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1:\Building\Sewer'rally\Scu-cr 1-alIyShcct_4R1 10-_0711113.x1sx