Permit (237) CITY OF TIGARD SEWER CONNECTION PERMIT
:', COMMUNITY DEVELOPMENT Permit#: SWR2019-00147
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/16/2019
TIGARD
Parcel: 25101 DC03900
Jurisdiction: Tigard
Site address: 7150 SW SANDBURG ST
Project: Immunology Consultants Laboratory(ICL) Subdivision: SALEM FREEWAY SUBDIVISION Lot: 4
Project Description: 3.06 EDU increase.
Contractor: Owner: LESLIE SANDBURG LLC
ATTN: JOHN G LESLIE
14056 GOODALL RD
LAKE OSWEGO, OR 97034
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/16/2019 $17,289.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 3.06
Total $17,289.00
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 1.800.332.234-.
Issued By: — Permittee Signature:
Call 50 • 5 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'ob site at the time of each ins.ection.
UPIAccumulative Sewer Tally
{s " Tenant Name: IMMUNOLOGY CONSULTANTS LABORATORY(ICL) SWR# 2019-00147
Site Address: 7150 SW SANDBURG ST PLM# 2019-00207
TIGARD
Parcel#: 2S 101 DC03900
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 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 4 8 0 -4 -8
Sink:
-Lav/Bar-Non-Food Related 2 0 5 10 36 72 31 62
-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 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 5 30 5 30 0 0
Urinal 6 0 3 18 2 12 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 17 66 44 115 27 49
Current Fixture Value 49 divided by 16= 3.063 Current EDU 1 EDU= $5,650.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 49 divided by 16= 3.063 over (under) $ 17,289.00
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:
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 5/15/2019
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
_,c„hmitrs.rl to the City n£Tirar1l Tr 1,-in8 Divicinn to rerl.Pm rrirlitc tnmarrlc 5,tnrr system develnpment charges
I:\Building\Sewer Tally\SewerTallySheet_5500_070118.xlsx