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Permit CITY OF TIGARD SEWER CONNECTION PERMIT IIII COMMUNITY DEVELOPMENT Permit#: SWR2015-00018 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/03/2015 Parcel: 2S 101 DA00102 Jurisdiction: Tigard Site address: 13221 SW 68TH PKWY 500 Project: University of Phoenix Subdivision: VARNS ACRES Lot: 9 Project Description: .13 EDU increase Contractor: Owner: GK TRIANGLE CORPORATE PARK III L BY THOMSON REUTERS INC ATTN: MEGAN DOWLING PO BOX 130174 CARLSBAD,CA 92013 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 03/03/2015 $637.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .13 Total $637.00 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 232.1987 or 1.800.332.2344. Issued y: Permittee Signature: x �� 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. c lig Tenant Name: University of PhAoenixcumulative Sewer Tally SWR# 2015-00018 Site Address: 13221 SW 68th Pkwy#500 PLM# 2015-00060 Parcel#: 2S 101 DA00102 Fixture \Alin I'rcAionis Previous Credits Capped Fixture Fixture New New ‘alue count capped#s value count added# added value total#s total values Baptistry/Font 4 0 U 0 0 0 Bath: -Tub/Shower 4 0 U 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 U 0 0 0 Cuspidor/Water Aspirator 1 0 II 0 0 (I Dishwasher: -Commercial 4 0 0 0 0 (I -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 U 0 0 (I Eye Wash 1 0 0 0 0 (I Floor Drain/Sink: -2 inch 2 0 0 0 0 (I -3 inch 5 0 0 0 0 U -4 inch 6 0 U 0 0 0 -Car Wash 6 0 U 0 0 0 Garbage Disposal: -Domestic(to 3/4 HP) 16 0 0 0 0 0 -Commercial(to 5 l IP) 12 0 0 0 0 0 -Industrial(over 5 11P) 42 0 U 0 0 0 Ice Machine/Refrigerator Drain 1 0 U 0 0 0 Living Unit 16 0 U 0 0 _ 0 Oil Sep(Gas Station) 6 U 0 0 0 0 Rec.Vehide Dump station 16 U U 0 0 0 Shower. -Gang(per head) 1 U 0 0 0 0 -Stall 2 U U 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 0 I 2 1 2 -Bradley 5 0 U _ 0 0 0 -Com/Sery/Util-Food Related 3 0 U 0 0 0 Swimming Pool Filter I 0 It 0 0 0 Washer-Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 (I U 0 _ 0 0 Urinal 6 0 II 0 0 0 Previous EDU Count U 0 Capped EDU Credit 0 TOTALS _ 0 0 0 _ U I 2 1 2 Current Fixture Value 2 divided by 16= 0.125 Current EDU 1 EDU= $4,900.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 2 divided by 16= 0.125 over (under) S 637.00 Enter EDU Change Here 0.130 Notes: Authorized Name/Signature: Debbie Adamski Date: 3/2/2015 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. 1:\Building\Sewer Tally\Sewer TallySheet_4900._070114.xlsx