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Permit (18) CITY OF TIGARD SEWER CONNECTION PERMIT 1111 ' COMMUNITY DEVELOPMENT Permit#: SWR2017-00031 13125 SW Hall Blvd.,Ti Date Issued: 02/16/2017 TIC AI<t) and OR 97223 503.718.2439 9 Parcel: 1 S 135AB04500 Jurisdiction: Tigard Site address: 10250 SW GREENBURG RD 115 Project: Reflex Subdivision: 1991-055 PARTITION PLAT Lot: 1 Project Description: .69 EDU increase Contractor: Owner: LINCOLN CENTER LLC BY SHORENSTEIN PROPERTIES LLC 555 CALIFORNIA ST 49TH FL SAN FRANCISCO, CA 94104 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 02/16/2017 $2,332.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .44 Total $2,332.00 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 3.232.1987 or 1.800.332.2344. Issued y: (-2Permittee Signature: <\c 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 III = Tenant Name: Reflex SWR# 2017-00031 TI G n K D Site Address: 10250 SW Greenburg Rd#115 PLM# 2017-00017 Parcel#: 1S 135AB04500 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 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 -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 0 0 0 Sink: -Lay/Bar-Non-Food Related 2 0 2 4 1 2 -1 -2 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 1 3 1 3 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 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 2 4 3 11 1 7 Current Fixture Value 7 divided by 16= 0.438 Current EDU 1 EDU= $5,300.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 7 divided by 16= 0.438 over (under) $ 2,332.00 Enter EDU Change Here 0.440 * *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: 1/24/2017 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