Permit wmakta SEWER CONNECTION PERMIT
: ; CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: SWR2009 -00060
� 13125 S H all Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/04/2009
(�ARD g Parcel: 1S134BC00300
Jurisdiction: Tigard
Site address: 12210 SW SCHOLLS FERRY RD
Subdivision: Lot: 0
Project: Coffee Rush
Project Description: 1.1 EDU to connect new manufactured structure to sewer service.
FEES
Owner:
FW OR- GREENWAY TOWN CENTER LLC Description Date Amount
PO BOX 790830 Sewer Inspection - Commercial 08/04/2009 $45.00
SAN ANTONIO, TX 78279 Sewer Connection Fee 08/04/2009 $3,960.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: CMS
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: .9
Total $4,005.00
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 th ules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. Yo ay obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: 1 l (1 l (\ 0 n Permittee Signature:
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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.
Accumulative Sewer Tally Parcel # 1 S134BC00300
Tenant Name: Coffee Rush This SWR# 2009 -00060
Site Address: 12210 SW Scholls Ferry Rd This PLM# 2010 -00032
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count N 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 2 4 2 4
- 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 HP) 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 1 2 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 2 6 2 6
- 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 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 6 18 6 18
Current Fixture Value 18 divided by 16 = 1.1 Current EDU 1 EDU = $ 3,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 18 divided by 16 = 1.1 over (under) $ 3,960.00
Enter EDU Change Here 1.1
Notes: Initial sewer connection, 1 EDU miniumum charge . 3- compartment sink not counted as it is draining into floor sink.
Authorized Name /Signature: Debbie Adamski Date: 7/2/2009
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- 3600.xls 06/25/08