Permit (99) CITY OF TIGARD SEWER CONNECTION PERMIT
1111COMMUNITY DEVELOPMENT Permit#: SWR2015-00175
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/25/2016
Parcel: 2S 102AD02900
Jurisdiction: Tigard
Site address: 12790 SW ASH AVE
Project: Burnham&Ash Apartments Subdivision: BURNHAM TRACT Lot: 5
Project Description: Building 2-27 EDU's(26 apt units&2 retail spaces)-2 EDU demo credits from BUP2000-00222&
BUP2011-00143 for 25 EDU's to be charged.
Contractor: Owner: PREMIUM PROPERTY-TIGARD LLC
1015 NW 11TH AVE, STE 243
PORTLAND, OR 97209
PHONE: PHONE: 503-226-1972
FAX:
FEES
Description Date Amount
_
Specifics: Sewer Inspection-Commercial 01/25/2016 $45.00
Sewer Connection Fee 01/25/2016 $127,500.00
Type of Use: MF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 27
Total $127,545.00
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. T • - 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 OU by calling .232.1•:7 or 1.800.332.2344.
I- ued By: /' / ; Permittee Signature:
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.
Accumulative Sewer Tally
Tenant Name: Burnham&Ash Apartments-Building 2 SWR# 2015-00175
Site Address: 12790 SW Ash Ave PLM# 2015-0(085
Tic, URI)
Parcel#: 2S102AD02900
Fixture Value Previous Previous Credits Capped Fixture Fixture Aew New
# value count capped#s value count added# added value n,ta] #5 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 0 0 0
-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 3/411P) 16 0 0 0 0 0
-Commercial(to 5 I 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 Unit 16 0 0 26 416 26 416
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
-Sr.tll 2 0 0 0 0 0
Sink:
-Lay/Bar-Non-Food Related 2 0 0 2 4 2 4
-Bradley 5 0 0 0 0 0
-Com/Sery/Uti] Food Related 3 0 0 0 0 0
Swimming Pool I i l t c 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 Il 0 0 0
Previous l IDU Count 0 0
Capped EDU Credit 2 32
TOTALS 0 0 0 0 30 432 30 400
Current Fixture Value 400 divided by 16= 25.000 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 400 divided by 16= 25.000 over (under) $ 127,500.00
Enter EDU Change Here 25.000 *
*Round EDUs 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: Residential Rate 1 shall include all common facilities as long as they are located on the same tax lot&are intended for the sole use of the residents.The 2
lays&2 toilets are for the retail spaces&calculated at the fixture rate.Demo credits from BUP2000-00222&BUP2011-00143 were applied.
Authorized Name/Signature: Debbie Adamski Date: 1/19/2016
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.
I:\Building\Sewer Tally\SewerTallySheet_5100_070115.xlsx
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Debbie Adamski
From: Whitney Williams
Sent: Thursday, October 22, 2015 1:32 PM
To: Debbie Adamski
Subject: RE: The Burnham & Ash Apartments
The only DU credit I can find is from 12800 SW Ash Ave and it is only 1 DU. As for water meters, there was only one 2"
water meter. You can pass that along to them if you'd like and if they have further questions just refer them to me.
Sound good?
\V'hiaicy Williams
City of Tigard
Sr. Accounting Assistant
(503) 718-2485
From: Debbie Adamski
Sent: Thursday, October 22, 2015 1:14 PM
To: Whitney Williams
Subject: The Burnham &Ash Apartments
Whitney,
Can you help me out? The Burnham and Ash Apartments (2 separate buildings) are going to be built on the old public
works and dog park sites. Can you tell me how many DU's the following three lots were being billed (if they were being
billed) for so I can credit the sewer fees on the new construction.
2S102AD03000, 12800 SW Ash Ave, old public works yard
2S102AD02900, no address, old dog park
2S102AD02800, no address
Also, the developers are wanting to know what size the existing water meters are on this site. Do you want to pass that
information on to me to reply with this request, or do you want me to refer her to you? Thanks and let me know if you
have any questions.
Debbie Adamski
Senior Building Permit Technician
City of Tigard I Community Development
13125 SW Hall Blvd.,Tigard, OR 97223
503-718-2450
DISCLAIMER: E-mails sent or received by City of Tigard employees are subject to public record laws. If requested, e-mail
may be disclosed to another party unless exempt from disclosure under Oregon Public Records Law. E-mails are retained
by the City of Tigard in compliance with the Oregon Administrative Rules "City General Records Retention Schedule."
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CITY OF TIGARD BUILDING PERMIT
11111 B .' COMMUNITY DEVELOPMENT Permit#: BUP2015-00208
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/27/2015
Parcel: 2S102AD03000
Jurisdiction: Tigard
Site address: 12800 SW ASH AVE
Project: Burnham&Ash Apartments Subdivision: BURNHAM TRACT Lot: 5
Project Description: Demolition of(4)buildings:3,120,3,090, 1,824,and 780 sq.ft. 12/23/15,DEMO CREDIT FOR 1 DU APPLIED TO
SWR2015-00174.
Contractor: LAKE OSWEGO INSULATION CO Owner: TIGARD, CITY OF
5930 JEAN ROAD 13125 SW HALL
LAKE OSWEGO, OR 97035 TIGARD, OR 97223
PHONE: 503-245-6460 PHONE:
FAX:
Specifics: FEES
Description Date Amount
Type of Use: COM
Class of Work: DEM Type of Const: Permit Fee-Additions,Alterations, 07/27/2015 $744.51
Demolition
Occupancy Grp: Occupancy Load: Erosion Control w/Development-Eng 07/27/2015 $161.40
Dwelling Units: 0 DC Provision Review,COM TI-Ping 07/27/2015 $88.00
Stories: 0 Height: 0 ft Info Process/Archiving-Sm$0.50(up to 07/27/2015 $1.50
Bedrooms: 0 Bathrooms: 0 11x17)
Value: $51,543
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $995.41
Required: Required Items and Reports(Conditions)
1 Ersn Cntrl 503-639-4175
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
/441-1.4_464.... oc. e40.4.44-4_
4t CITY OF TIGARD BUILDING PERMIT
*- COMMUNITY DEVELOPMENT Permit a: BUP2009-00143
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.639.4171 Date Issued: 08/03/2009
Parcel: 2S102AD02800
Jurisdiction: Tigard
Site address: 9020 SW BURNHAM ST
Subdivision: BURNHAM TRACTS Lot: 5
Project: City of Tigard
Project Description: Demo existing 2000 sq ft structure. Sewer is to be capped and inspected. SDC credits available
for future construction.
Owner: FEES
TIGARD, CITY OF Description Date Amount
13125 SW HALL BLVD Permit Fee-COM 08/03/2009 $62.50
TIGARD, OR 97223 Erosion Control 08/03/2009 S26.00
PHONE: Erosion Plan Review CWS 08/03/2009 $8.45
Erosion Plan Review COT 08/03/2009 $8.45
Contractor:
OWNER
PHONE:
FAX:
Specifics:
Type of Use: COM
Class of Work: DEM
Dwelling Units: 0
Stories: 0 Height: 0 ft
Bedrooms: 0 Bathrooms: 0
Value: $2,000
Floor Areas:
Total Area: 0
Accessory Struct: 0
Basement: 0
Carport: 0
Covered Porch: 0
Deck: 0
Garage: 0
Mezzanine: 0
Total $105.40
Required: c Required Items and Reports(Conditions)
Fire Sprinkler: Parapet: C�y�4� eo�T2vL
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking: 0
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 wo k is suspended for more the 180
days.ATT • •• = -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center Those ml s are set forth in/•►70.-
952-00 0010 through O•'95 401-0100. You may obtain a copy of the rules or direct questions to OUNC by call; e :246.6699 or 1.84 w'gra •. 4
Issu By: ,,� •I ! Permittee Signature: 1214
Call 503.6 9.4175 by 7:00 a.m.for an inspection that b :loess day.
This permit card shall be kept in a conspicuous place on the Job site until comple on of the project.
Approved plans aro required on the job site at the time of each inspi.tion.
7
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CITY OF TIGARD BUILDING PERMIT
' '� I COMMUNITY DEVELOPMENT Permit#: BUP2000-00222
T[GARB 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/15/2000
Parcel: 2S102AD02900
Jurisdiction: TIG
Site address: 12770 SW ASH AVE
Project: CITY OF TIGARD Subdivision: Lot:
Project Description: Demolition of a 1000 sq.single family unit.Sewer will be capped in the a.m. All debris to be removed.
4/19/11: DEMO CREDITS APPLIED TO PLM2011-00125.
Contractor: Owner: CITY OF TIGARD
13125 SW HALL
TIGARD, OR 97223
PHONE: PHONE: 503-639-4171
FAX:
Specifics: FEES
Description Date Amount
Type of Use: SF
Class of Work: OTR Type of Const: [BUILD]Permit Fee 06/15/2000 $50.00
Occupancy Grp: Occupancy Load: [TAX]8%State Tax 06/15/2000 $4.00
[ERPRMT]Erosion 06/15/2000 $26.00
Dwelling Units: [ERPLN]Ero Plck-USA 06/15/2000 $8.45
Stories: Height: ft [EROSN]Ero Plck-COT 06/15/2000 $8.45
Bedrooms: Bathrooms:
Value: $3,000
Floor Areas:
Total Area:
Accessory Struct:
Basement:
Carport:
Covered Porch:
Deck:
Garage:
Mezzanine:
Total $96.90
Required: Required Items and Reports(Conditions)
Fire Sprinkler: Parapet:
Fire Alarm: Protected Corridors:
Smoke Detectors: Manual Pull Stations:
Accessible Parking:
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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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 PLUMBING PERMIT
1111 ' COMMUNITY DEVELOPMENT Permit#: PLM2011-00125
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04!19/2011
Parcel: 2S102AD02900
Jurisdiction: Tigard
Site address: 12780 SW ASH AVE
Project: City of Tigard-Dog Park Subdivision: BURNHAM TRACTS Lot: 5
Project Description: (1)catch basin,(1)backflow device,(1)drinking fountain,(1)hose bib, 10 If sanitary sewer,90 If water service.
DEMO CREDITS apply from BUP2000-00222. No sewer permit required-issued sewer tally sheet with EDU
credits.
Contractor: KODIAK PACIFIC CONSTRUCTION Owner: CITY OF TIGARD
PO BOX 886 13125 SW HALL BLVD
TUALATIN, OR 97062-0886 TIGARD, OR 97223
PHONE: 503-783-4300 PHONE:
FAX: 503-682-3777
FEES
Quantity Description Date Amount
1 ea Catch Basin or Area Drain 04/19/2011 $18.76
Specifics: 10 If Sewer Service 04/19/2011 $62.54
90 If Water Service 04/19/2011 $62.54
Type of Use: COM 1 ea Backflow Preventer 04/19/2011 $31.27
Class of Work: NEW 1 ea Drinking Fountain 04/19/2011 $25.02
Type of Const: 1 ea Hose Bib 04/19/2011 $25.02
Occupancy Grp: 1 12%State Surcharge- 04/19/2011 $27.02
Stories: 1 Plumbing
Total $252.17
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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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.