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Permit (20) CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT WW��,�" Permit#: SWR2016-00332 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2016 T[ �"" tL g Parcel: 2S102AD02700 Jurisdiction: Tigard Site address: 8970 SW BURNHAM ST Project: Pacific Rim Martial Arts Academy Subdivision: BURNHAM TRACT Lot: 5 Project Description: 1.63 EDU increase. 4/27/17:REPRINTED permit to include(2)new sinks;Total EDU increase is 1.88. Contractor: Owner: MARTYN PROPERTIES LLC 17051 SW RIVENDELL DR PORTLAND, OR 97224 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 04/27/2017 $9,964.00 Type of Use: COM Class of Work: ADD Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 1.88 Total $9,964.00 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 calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Cal ....39.4175 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 114 . 4 Tenant Name: Pacific Rim Martial Arts Academy SWR# 2016-00332 REVISION 1 T1A Site Address: 8970 SW Burnham St PLM# 2016-00506 Parcel#: 2S102AD02700 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 1 2 1 2 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 -4inch 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 1 2 1 2 Sink: -Lay/Bar-Non-Food Related 2 0 0 4 8 4 8 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 1 6 1 6 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 9 30 9 30 Current Fixture Value 30 divided by 16= 1.875 Current EDU 1 EDU= $5,300.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 30 divided by 16= 1.875 over (under) $ 9,964.00 Enter EDU Change Here 1.880 * *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: 4/27/17:Added(2)sinks. Authorized Name/Signature:Debbie Adamski Date: 10/4/2016 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_5300_070116.xlsx CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT Permit#: SWR2016-00332 D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2016 i °'� g Parcel: 2S102AD02700 Jurisdiction: Tigard Site address: 8970 SW BURNHAM ST Project: Pacific Rim Martial Arts Academy Subdivision: BURNHAM TRACT Lot: 5 Project Description: 1.63 EDU increase Contractor: Owner: MARTYN PROPERTIES LLC 17051 SW RIVENDELL DR PORTLAND, OR 97224 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 10/24/2016 $8,639.00 Type of Use: COM Class of Work: ADD Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 1.63 Total $8,639.00 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 calling 503.232.1987 or 1.800.332.2344. Issued By: gt.iiretee„..„ Permittee Signature: C 3.639.4175 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 III Tenant Name: Pacific Rim Martial Arts Academy SWR# 2016-00332 TIGA RD Site Address: 8970 SW Burnham St PLM# 2016-00506 Parcel#: 2S 102AD02700 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 1 2 1 2 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 3/4 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 1 2 1 2 Sink: -Lay/Bar-Non-Food Related 2 0 0 2 4 2 4 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer-Clothes 6 0 0 1 6 1 6 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 7 26 7 26 Current Fixture Value 26 divided by 16= 1.625 Current EDU 1 EDU= $5,300.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 26 divided by 16= 1.625 over (under) $ 8,639.00 Enter EDU Change Here 1.630 * *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: Authorized Name/Signature: Debbie Adamski Date: 10/4/2016 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_5300_070116.xlsx