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Permit (166) ,, CITY OF TIGARD SEWER CONNECTION PERMIT 2 . COMMUNITY DEVELOP Permit#: SWR2018-00076 DEVELOPMENT TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/23/2018 Parcel: 25101 DA00101 Jurisdiction: Tigard Site address: 13190 SW 68TH PKWY 130 Project: Spec Space Subdivision: VARNS ACRES Lot: 9 Project Description: .38 EDU increase Contractor: Owner: PACIFIC NW PROPERTIES LIMITED PA STERN FAMILY LIMITED PARTNERSHIP STERN, HELEN R REVOCABLE TRUST 6600 SW 105TH AVE#175 BEAVERTON, OR 97008 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 03/23/2018 $2,090.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .38 Total $2,090.00 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�.1/ 7 or 1.800.332.2344. Issued By: ,,e`( / ��!! li -671–e.— Permittee Signature: '''‘,/ ,1 J° Z-.f 69_770 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 2 41 Tenant Name: Spec Space SWR# 2018-00076 T I GA RD Site Address: 13190 SW 68th Pkwy,Ste 130 PLM# 2018-00121 Parcel#: 2S 101 DA00101 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 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 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 -Stall 0 2 0 0 S 0 0 0 Sink: -Lav/Bar-Non-Food Related 2 0 0 1 2 1 -Bradley 5 0 2 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 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet-Toilet 6 0 0 0 0 Urinal 6 0 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 3 6 3 6 Current Fixture Value 6 divided by 16= 0.375 Current EDU 1 EDU= $5,500.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 6 divided by 16= 0.375 over (under) $ 2,090.00 Enter EDU Change Here 0.380 * *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: Dianna Howse Date: 3/22/2018 Building Division rote: 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