Permit (173) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2016-00008
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/04/2016
Parcel: 2S113AB00600
Jurisdiction: Tigard
Site address: 16160 SW UPPER BOONES FERRY RD
Project: Phytelligence Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30
Project Description: Interior plumbing for TI:Adding(2)2"floor drains,(1)sink,(1)water closet,and(1)urinal;Relocating(1)2"floor
sink,(1)shower stall,(3)sinks,and(2)water closets.
Contractor: Owner: PACIFIC REALTY ASSOCIATES LP
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 02/04/2016 $5,763.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.13
Total $5,763.00
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 ;in.
egon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You copy of a rule or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Signature:
Call 503. 9. by 7:00 a.m.for the next available insp
This permit card shall be kept in a conspicuous place on the job site unta project.
Approved plans are required on the job site at the time of e
Accumulative Sewer Tally
� I'enant Name: PI IYTFLI,IGENCI,, SWIZ# 2016-00008
Sitc Address: 16160 SW UPPER BOONF,S FERRY RD P1.M# 2016-00049
Parcel#: 2S113AB00600
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Ba tiscry/Dont 4 0 0 0 0 0
Bath: -Tub/Shower 4 0 0 0 0 0
Jacuzzi/W`hirl ool 4 0 0 0 0 0
Car\Vash: -1?ach 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
I?yc 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
(,at Wash 6 0 0 0 0 0
Garbage Disposal:
Domestic(to 3/4 I11)) 16 0 0 0 0 0
-Commercial(to 5 IIP) 32 0 0 0 0 0
-Industrial (over 5 111)) 42 0 0 0 0 0
Ice Machinc/Refrigerator Drain 1 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 1 0 0
Stall 2 0 0 0 0 0
Sink:
Lav/Bar-Non-Food Related 2 0 0 1 2 1 2
Bradley 5 0 0 0 0 0
Com/Scry/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 HAtractor 6 0 0 0 0 0
Water Closet-Toilct 6 0 0 1 6 1 6
Urinal 6 0 0 1 6 1 6
Previous 1?DU Count 0 0
Capped FDU Credit 0
I'O'1'.AI,S 0 1 0 0 1 0 1 5 1 18 5 18
Current Fixture Value 18 divided by 16= 1.125 Current FDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous F.DU
Change 18 divided by 16= 1.125 over (under) S 5,763.00
Enter EDU Change Here 1.130
`Round FDUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: Date. 2/3/2016
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.
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