Permit CITY OF TIGARD SEWER CONNECTION PERMIT
° '! 44
COMMUNITY DEVELOPMENT Permit#: SWR2016-00004
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/09/2016
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 200
Project: I Love Kick Boxing Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: .25 EDU increase.
Contractor: Owner: ROBINSON, CONSTANCE A
BY KILLIAN PACIFIC LLC
500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/09/2016 $1,275.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .25
Total $1,275.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if
work is su . •ed or , e the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. hose rules are se o - OAR 952-001-0010 through OAR 952-001-009$. • ay os -in a copy of the rules or direct questions
to OU 4C by calling 503.232.1987• 1.81 .332.2344. 4116k.ssued By: • ` Permittee Si.•ature: ) /, �/eifi �r
(Lii/La
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 u• completion of the project.
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
ligTe■
nant Name: I LOVE KICK BOXING SWR# 2016-00004
Site,Address: 10115 SW NIMBUS AV'I SUITE 200 PLM# 2016-00023
TIGARI)
Parcel#: .1S1 34AA01 900
I ixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
BaptiserV/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,Vspirator 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
-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 IIP) 16 0 0 0 0 0
-Commercial(to 5 III)) 32 0 0 0 0 0
-Industrial(over 5 I IP) 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 2 4 0 1 2 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 2 12 0 0 2 12
Urinal 6 0 0 0 0 0
Previous IDU Count 0 0
Capped I.DU Credit 0
T()T. 4 16 0 0 2 4 6 20
Current Fixture Value 20 divided by 16= 1.250 Current 1DU 1 EDU= $5,100.00
Previous Fixture Value 16 divided by 16= 1.000 Previous I?D11
Change 4 divided by 16= 0.250 over (under) S 1,275.00
Enter EDU Change Here 0.250
*Round IDUs 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: BRANDI'.N TAGGART X2449 Date: 1/26/2016
Building Division
Note: The property owner shall retain the ORIGIN AI.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:ABuilding\Sewer Tally\Sewer'I'allyShcct_511111_11711115.xlsx