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Permit (137) - , CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT Permit#: SWR2018-00064 TIARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/06/2018 Parcel: 2S101 AB03100 Jurisdiction: Tigard Site address: 12115 SW 70TH AVE 200 Project: Dr.Steven Gabel MD PC Subdivision: 2012-009 PARTITION PLAT Lot: 3 Project Description: 3.06 EDU Increase Contractor: Owner: TIGARD TRIANGLE PARTNERS LLC 18187 SIERA DR LAKE OSWEGO, OR 97034 PHONE: PHONE: FAX: FEES Description Date Amount Saecifiics: Sewer Connection Fee 03/02/2018 $16,830.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: 3.06 Total $16,830.00 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 503.232 987 or 1.800.332.2344. Issued By: d/ t 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. _ Tenant Name: Dr Steven Ga Abelccumulative Sewer Tally SWR# 2018-00064 T I G A R n Site Address: 12115 SW 70th Ave PLM# 2018-00068 Parcel#: 2S101AB03100 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 1 1 1 1 Floor Drain/Sink: -2 inch 2 0 0 1 2 1 2 -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: -Lav/Bar-Non-Food Related 2 0 0 14 28 14 28 -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 19 49 19 49 Current Fixture Value 49 divided by 16= 3.063 Current EDU 1 EDU= $5,500.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 49 divided by 16= 3.063 over (under) $ 16,830.00 Enter EDU Change Here 3.060 * *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: All newly added fixtures for new tenant space. Authorized Name/Signature: Dianna Howse Date: 2/22/2018 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_5500_070117.xlsx