Permit CITY OF TIGARD SEWER CONNECTION PERMIT
11111 COMMUNITY DEVELOPMENT i 1 Permit#: SWR2015-00016
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 �v Date Issued: 02/25/2015
T[C�f4R_D g Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7244 SW DURHAM RD 300
Project: Ricoh Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 25-27,2:
Project Description: 1.25 EDU increase. 3/3/15, REPRINTED to correct ASI info
Contractor: Owner: PACIFIC REALTY ASSOCIATES
ATTN: N PIVEN
15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: PHONE: 503-624-6300
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/25/2015 $6,125.00
Typo of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.25
Total $6,125.00
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 c g 50 . 2.198 or
1.800.332.2344.
Issued B : Ge/'P6 Qv Permittee eeSignature
3 /
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.
„ CITY OF TIGARD SEWER CONNECTION PERMIT
€"'! I: COMMUNITY DEVELOPMENT Permit#: SWR2015 00016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/25/2015
Parcel: 2S113AC00103
Jurisdiction: Tigard
Site address: 7244 SW DURHAM RD 300
Project: Ricoh Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 25-27,2<
Project Description: 1.25 EDU increase.
Contractor: Owner: PACIFIC REALTY ASSOCIATES
ATTN: N PIVEN
15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: PHONE: 503-624-6300
FAX:
•
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/25/2015 $6,125.00
Type of Use:
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $6,125.00
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 •• of the rules or direct questions
to OUNC by ng .232.19887 or 1.800.332.2344. •I ssued B : a�� Permittee Signature: _
Call 503.639.4175 by 7:00 a.m.for the next available inspecti• date.
This permit card shall be kept in a conspicuous place on the job site until co pletion o • •ro'e t.
Approved plans are required on the job site at the time of each ins.= •• .
Ph --- 4 Accumulative Sewer Tally
Tenant Name: Ricoh SWR# 2015-00016
Site Address: 7244 SW Durham Rd.,#300 PLM# 2015-00055
Parcel#: 2S 113AC00103
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 1 2 1 2
-3inch 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
Living Unit 16 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 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 6 20 6 20
Current Fixture Value 20 divided by 16= 1.250 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 20 divided by 16= 1.250 over (under) $ 6,125.00
Enter EDU Change Here 1.250
Notes:
Authorized Name/Signature: Dianna Howse Date: 2/25/2015
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\SewerTallySheet_4900._070114.xlsx