Permit CITY TIGARD
SEWER CONNECTION PERMIT
74 ' ° COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00085
• R 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/30/2008
PARCEL: 2S102CC - 00500
SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG
PROJECT: H MART
Project Description: .8 EDU increase.
TENANT NAME: H MART
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 0.8
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
13500 PACIFIC CORP
BY CAP ADVISORS Description Date Amount
38345 W TEN MILE RD, STE 170
FARMINGTON HILLS, MI 48335 [SWUSA] Sewer Connection Fee 5/30/2008 $2,240.00
Phone: Total $2,240.00
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 r L Permittee Signature: �/ -
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.
05/29/2008 07:13 A.' 1 08 785 4 ., q,
•
_.binu Permit Application c'
Building Fixtures al, 1 i fi �t1 irzli ct,'a'rj :Yf �v �" t * � ^ ?y,VIVOWi � t
F i �' E ? V E L
Received
c� ��' s .y�, I "III � I I t k g , - ( � . I l i , ,,�t. *z f t r �l .` s }}� 1.
` , City of Tig Perrmt l :
Date/By: 5 ,r ray P e':
V 13125 SW Hall Blvd., Tigard, OR 97223 Mao Review
Ph 503.639.4171 Fax: 503.59�I h 9 ZO
e Date/By: Other Hermit No �,, , ... l
3
f: r�� Inspection Line: 503.639.4175
i, � DatcReadyBy: RI See • • Ztpr
z; ; Internet. www.tigard M Not df Methoa y s tat
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1 i - 7 t . 137, - -, :7 ,. 2 :.. ."52'.._a' - . -44 Luva. a - t. 1 v .y... L .c' .3. as ..S ,--;. + . r- - :nfi"�.. $Y.F`� /a, � - ... -.. -K "} �. .o ? . n _
0 New construction 0 Demoktion 11 or . - - narration us . .. , ..
Addition/alteration/replace/neat 0 - s ' . lion �� �a!/� Ea. Total
New I- 2-fain dw I legs (includes 1W . for each utility connection)
r ; ter t w s ,Tr - a -. SFR(1)bah 24920
u:� ,.---' s�..�. � ..f �._r=3 � -'u�.M s,..a+t �. .Ya,r�.t a_-F ;� ....... ��rW ��, ..,..,
0 1- and 2-family dwelling If Commercial/industrial SFR (2)h- 350.00
0 Accessory building 0 Multi - family SFR (3) bath 399.00
Each additional bath/kitchar 45.00
0 Master builder 0 Other
�' + r�� w � .� fi Fire sprinkler ( sq. ft) Page 2
�.1'.�:._ �.:a���r,.. ir„ -: z�_ �, = W � � s_ _ ���s =-, Site utilities
Job site address: i 31 0 0 S W (u G. , , <- /4 y Catch basin or area drain j 16.60
City/State/ZIP: - / - 7, q r c( 0 Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no.: ! Project name: N - M 0 i-i- Footing drain (no. linnet ft: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _J Page 2
Subdivision: )Lot no.:
Water service (no. linear R: _) Page 2
Tax map/parcel no.: Fixture or item
�� rr ..�_ : _ Absorption valve - 16.60
e Backflow prove mer Page 2
A 5' 4 // n e m1 - - k'f dr C $ r S S 4 • Backwater valve 16.60
6 or Clothes washer 16.60
Dishwasher 16.60
" cry`.; s1- s "- 7 �.* X �'-, } ,1 T±r."j'-� g.,.. Drinking fDrmtain 16.60
:ws&:.. .,? t m,. y .t'- tlii y'i,. ' x' e ?, 4 't _ x '^__z' mod E
_ _ Ejex;tors/s 16.60
Name: ) 75 Peg., - iL 1 c' f 6 y L.ii f i c/t/+(OrS Expansion tank 16.60
Address: 315 3 5 vi , / e K /tot i e K of ) Fixture/sewer cap 16.60
City/StateIZlP: F. r ,1,) - y,A P e' Its A -[- 5 / 333 5 Floor drain/floor sin /hub 16.60
Phone: (So3) .. Z 6 '- 6; Z a Fax: (5'03) ,, 2 0 °- 6 S / Garbage disposal 16.60
--Y « ?tri. Hose bib 16.60
x _ 41 r. -. . _.,Q. r .:.ri.�---._ a. : .41 . r. __. .� . Ice maker 16.60
Business na e - 3 el o
Contact name: interceptor /grease trap / 16.6() i 6 . E 0
Medical gas (value: S ) Page 2
Address: Pricier 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) i Fax: : ( ) Sink/basin/lavatory 2/ 16.60 i4 . y 0
Tub/shower /shower pan 16.60
E-mail C +6 4. 5 /iA, IN S _ . Pt I/ t we u Gto() 1 C O .a.‘.
3:14vi ":5 S : T, i sr '-t°r- 5 < -7 r : � y a - ., Urine) 16.60
- . - 4 . - , -2. , ' - ..r = = Water closet 16.60
Business name: 444 ci 5 f l •~t E1;tn, n. �/ a c.'/-d c^ y Water teeter 16.60
Address: r 0, u', ,.,.- r3 5 2 Other:
city/state/ZW: IQ i 1n /
J Q 04 ( i 4- 8 f iY Z subtotal as
Minimum permit fee: 572.50 `
Phone: (3 ) /1 7 .- g 0 5 Fax: (Tic ) g 3 7 - 5' 50 `( Residential backflow minimum permit fee: $36.25
CCB Lk.: / 6 6-7/ 5' Plumbing Lic. no. :'`ri j i 471 ? Plan review (25% of permit fee)
� State surcharge (12% of permit fee) q ,y6
Atahorized signature: �,
E' ca n e'` TOTAL PERMIT FEE 1 y a 9 b
I Print name: - -z e 0. (owNE%) Date: rj = 2 9' d F This permit application expires if a permit is not obtained within
180 days alter it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:iBuudivgVPc PLMF- PermitApp.doc 12/27D6 440.4616T(IWIO2/COM/WES)
$; ( fees ' 444---
1 st�I) r -, 33D-..ctc
• Accumulative S wer Tally Parcel # 2S102CC -00500
T A5
cumulative
Name: H MAR 6 u ,.. 0, 64) This S \X/R# SWR2008 -00085
Site Address: 13600 SW PACIFIC HWY This PLM# PLM2008 - 00243
Fixture Value Previous Previous Credits Capped Fixture Fixture New Nev.
# 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 / \X/hirlpool 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 0 0 0
- 4 inch • 6 0 0 0 0 0
- Car Wash Drn 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 1 -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 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 - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 , ' 0 0 0 0 0
- Commercial 3 0 0 4 12 4 12
- 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 12 4 _ 12
Current Fixture Value 12 divided by 16 = 0.8 Current EDU 1 EDU = $ 2 ,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 12 divided by 16 = 0.8 over (under) $ 2,240.00
Enter EDU Change Here 0.8
Notes:
Authorized Name /Signature: Branden Taggart Date: 5/30/2008
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:\ Building \Sewer Tally \SewerTallySheet- 2008.x]s 06/30/07