Permit 7
CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00093
Tici∎05 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/19/2008
PARCEL: 2S 102CC - 00500
SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG
PROJECT: H MART
Project Description: .5 EDU increase.
TENANT NAME: H MART
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 0.5
TYPE OF USE: CMS NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner:
13500 PACIFIC CORP FEES
BY CAP ADVISORS Description Date Amount
38345 W TEN MILE RD, STE 170
FARMINGTON HILLS, MI 48335 [SWUSA] Sewer Connection Fee 6/19/2008 $1,400.00
Phone: Total $1,400.00
Contractor:
Contact #:
REQUIRED ITEMS AND REPORTS
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the
date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer
laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given.
If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon
law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through
OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued by `z, /`/ /�/ 4 ,,19 1111 1 - Permittee Signature: C / �I�■.„.._
,I
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
06/12/2008 13:31 FAX 13608878504 2001
•
e
JUN 1 220
CT
PLUMBING
CONTRACTORS
31020 NW 81° Avenue
PO Box 1352
Ridgefield, WA 98642
Fax: 360-887-8604
Atlasplumbingllcayahoo.com
FAX TRANSMITTAL FORM
To: 6" Dr
Attn:
From:
Date Sent: 6 -/ 2 -0 e
Phone:
Fax: 503 - 59V - j7°
Number es: 5 Includinq covezpae
Message,
oeec4
- czd at Acic-kAi-J •i • pf
e f PlA , 1 1 4 • - . "17) e co R. _
C ± P • ; tO(e, ft ike_
a LA-7 g e bLi, 5
64 0, PM.
ThE7
• Lo,
Travis Zea A / /did
( ) et-,tQcf2;_lii 6174-) 6(
• ) 6 " ketei-/-- 1 1 C-6- •
A-44-1 l .
)
• 4 1
6'7/;•1 O 4 ) /0441_ 1 e cAL4u-ot-.4-6a)
' Accumulative Sewer Tally Parcel # 2S1102CC -00500
Tenant Name: I -I Mart This SWR# 2008 - 00093
Site Address: '`13600 SW Pacific I-Iwy This PLM# 2008 - 00258
Fixture Value Previous Previous Credits Capped Fixture Fixture New Ncw
# value capped off value added added total total
count off #s count # value #s 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 1 5 1 5
- 4 inch 6 • 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
Domestic (to 3/4 1 IP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 • 0 0 0 0 0
- Industrial (over 5 1-IP) 42 0 •• 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 3 3 3 3
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 - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 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 0
Urinal 6 0 0 0 0 0
Previous EDU Count • 0 0
Capped EDU Credit 0
TOTALS 0 0 0 _ 0 4 8 4 8
Current fixture Value 8 divided by 16 = 0.5 Current EDU 1 EDU = S 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 8 divided by 16 = 0.5 over (under) S 1,400.00
Enter EDU Change Here 0.5
Notes:
Authorized Name /Signature: Debbie Adams16 Date: 6/10/2008
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: \Buil ding \ Sewer "I' ally\ tiewer'CallyShcct- 2008.xls 06/30/07