Permit (97) CITY OF TIGARD SEWER CONNECTION PERMIT
fi Permit#: SWR2017-00285
a COMMUNITY DEVELOPMENT 1x "
Tigard OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti • ` Date Issued: 01/04/2018
T i(a,t1[t.D9
/7 AP lire Parcel: 2S102CB00200
Jurisdiction: Tigard
Site address: 13115 SW PACIFIC HWY
Project: Specialty Retail Subdivision: None Lot: None
Project Description: Sewer connection for a new 15,085 SF commercial building:4.0 EDU'S. 9/11/2018: REPRINT permit to correct site
address.
Contractor: Owner: TIGARD PACIFIC RE LLC
C/O LEADERSHIP CIRCLE LLC
1521 OXBOW DR STE 210
MONTROSE,CO 81401
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Sewer Connection Fee 12/19/2017 $21,200.00
Sewer Inspection-Commercial 12/19/2017 $45.00
Type of Use: COM
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 4
Total $21,245.00
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. .1987 or 1.800.332.2344.
Issued By: v% Permittee Signature: 77ic.)
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 SEWER CONNECTION PERMIT
r s.'.'y, COMMUNITY DEVELOPMENT Permit#: SWR2017-00285
TEGARD13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 01/04/2018
g Parcel: 2S102CB00200
Jurisdiction: Tigard
Site address: 13125 SW PACIFIC HWY
Project: Specialty Retail Subdivision: None Lot: None
Project Description: Sewer connection for a new 15,085 SF commercial building:4.0 EDU'S.
Contractor: Owner: TIGARD-TUALATIN SCHOOL
DISTRICT 23J
6960 SW SANDBURG ST
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 12/19/2017 $21,200.00
Type of Use: COM Sewer Inspection-Commercial 12/19/2017 $45.00
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 4
Total $21,245.00
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 rule .r direct questions
to OUNC by calling 503.2332.1987 or 1.80033 . `,
Issued By: lf.� _ . rmittee Signature:
_........010100. -----
.G--
Call
Call 503.639.4175 by 7:00 a.m.for the next available inspec •- :—. -.
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: SPECIALTY RETAILER SWR# 2017-00285
Site Address: 13125 SW PACIFIC HWY
PLM# 2017-00259
Parcel#: 2S102CB00200
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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 14 28 14 28
-3inch 5 0 0 0 0 0
-4inch 6 0 0 1 6 1 6
-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 1 1 1 1
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 0 0 8 16 8 16
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 4 12 4 12
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 0 0 0 0 0
Urinal 6 0 0 0
0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 29 64 29 64
Current Fixture Value 64 divided by 16= 4.000 Current EDU 1 EDU= $5,300.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 64 divided by 16= 4.000 over (under) $ 21,200.00
Enter EDU Change Here 4.000 *
*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:
Authorized Name/Signature:BRANDEN TAGGART X2449 Date: 8/30/2017
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