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Permit CITY F TIGARD SEWER CONNECTION PERMIT 11114 - COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00043 :TIGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/31/2008 PARCEL: 2S102CC -00500 SITE ADDRESS: 13600 SW PACIFIC HWY ZONING: C -G SUBDIVISION: TIGARD MARKETPLACE LOT: JURISDICTION: TIG PROJECT: H MART Project Description: .9 EDU increase. TENANT NAME: CWS NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS: 1.0 TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: LTPSWR 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 3/31/2008 $2,520.00 Phone: Total $2,520.00 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: G��,ste 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. 7 3 5 0 b(). PCf-i '2c'C 'i'v P.02 Mar,-28-0803:16P . .... 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' Ice insket . -- 71:0 -1. . --- 77 11,..,011,„„,,, _.. ___ Inrocophiegrease rraP 16.(j0 ) -- - , w ---- C:6 MCI 11:1Mt; Pm e Z W eas (whir S ) • • _ _ - A alma: Prinset - 16,6Tr -- 1 • ......._ _ - - - •::;rAlm'Zir. II aorcintitt wmptiereiAl) if Art 1 - 1 .... . ___. - Sugtfbakistilantovry 16 6.0 r'Sx•nc. ( ) 1 Fla: 1 ( ) ,- ......--........... n.b/SbloW041111111/11' Orm 1 n. 67 - i- n1 i1 ,.,-.... 16 en I ....._. fiLlri0C,1 16(U _01 1,.. .1.Infirtf 1. WUler AMC/ ......- MAX, 1 i6 .6u _ ." di gm; i i i .1.47.-- 4 _1 6 '&0 51 . /2614-C. Otkr: t-41/1.) Ok $4 1 31 •.... 1 2+7y/5744cJ7A r: p -4,4447 , 71 5 7I/7 __________S twit j 794. ,y-t) - Minimum parnii fee! 02.5t1 1 tilioric ti) ) Xi) - oto Fax: C 4 7 ) -,?4-,f -- -?C t," 4 Rexidential hick flu* . niimi..m.ts pennk RA. 136 .__---,, Plucrabinv 1.1c, no.: AO . 2 1 e Man review (ZS% Ef permit Ike) __ $tarc stinAmlyt ( tit ene.01 WI ' -, (, Authorize.; .iiinnue: ..; Wand. ITP.MIT F.L.t 7 , PI 713713C: ;15(.v . it , 41 oltd: ----) ,4 pii meatier;,,,p5,.. r a who/ 1, aat'amataad within - . iZ8 Joy, zft t( bus kun luterted vs wrap.... q. 2/27731 440460TilullAATAVW001 • 1'017 171 C 0 101/010P 7 0 by Tri Roildiil: 16..6•1 > borate). foot A ,.. 5- 3 -- .3-siq ..._ 00 c) 1 Accumulative Sewer Tally Parcel # 2S102CC - 00500 Ten3ntNainc: 1 -1 Mart This SWR# SWR2008 - 00043 Site Address: 13500 SW Pacific I -Iwy This PLM# PLM2008 - 00133 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # 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 Nash - 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 1-IP) 32 0 0 0 0 0 - Industrial (over 5 HP) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 48 48 17 17 31 31 62 62 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 48 48 _ 17 17 31 _ 31 62 _ 62 Current Fixture Value 62 divided by 16 = 3.9 Current EDU 1 EDU = $ 2,800 Previous Fixture Value 48 divided by 16 = 3.0 Previous EDU Change 14 divided by 16 = 0.9 over (under) $ 2,520.00 Enter EDU Change Here 0.9 Notes: Authorized Name /Signature: Branden Taggart Date: 3/31/2008 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.xls 06/30/07