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Permit CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT x Permit #: SWR2012 -00026 x i '�•• Date Issued: 02/22/2012 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 1 S 126CA01000 Jurisdiction: Tigard Site address: 9009 SW HALL BLVD 115 Project: Sport Clips Subdivision: VASHINGTON SQUARE ESTATES NO. Lot: 108 Project Description: .6 EDU increase. Revised 3/16/12, additional .7 EDU increase for new total increase of 1.3 EDU's. Contractor: Owner: CAFARO NORTHWEST PARTNERSHIP PO BOX 422 FLORHAM PARK, NJ 07932 PHONE: PHONE:- FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 02/22/2012 $2,700.00 Sewer Connection Fee 03/20/2012 $3,150.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: 3 Number of Dwelling Units: .6 • Total $5,850.00 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. T . - ru es = 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 calling 503.232.: 9: 0 1.8.: 332.2344. Issue. By: �� J Permittee Signatt e: s)-s � ���� Call 503.639.4175 by 7:00 a.m. for the next available inspectio e. /( 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. 711 Accumulative Sewer Tally 2 q ' Tenant Name: SPORT CLIPS 3/16/12 * ** SWR # SWR2012 -00026 TIGARD Site Address: 9009 SW HALL BLVD PI.M # PLM2012 -00035 Parcel #: 1 S126CA01000 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped #s value count added # added value total #s total values Baptistry/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 1 2 1 2 - 3 inch 5 0 0 0 0 0 - 4 inch 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 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: - I,av /Bar - Non -Food Related 2 0 0 6 12 6 12 - Bradley 5 0 0 0 0 0 - Com /Scrv/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 0 1 6 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 'l'O'1'A1 0 0 0 0 8 20 8 20 Current Fixture Value 20 divided by 16 = 1.3 Current ISDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 20 divided by 16 = 1.3 over (under) S 5,850.00 Enter EDU Change Here 1.3 Notes:3 /16/12, revising to add (5) additional sinks. Original EDU charge of .6, S2,700, was paid on 2/22/12. Additional fees due: $3,150. Authorized Name /Signature: BRANDEN T'AGGART /Debbie Adamski Date: 2/17/2012 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 \Sewerl'allyShect- 4500.xls 01/18/12 CITY OF TIGARD SEWER CONNECTION PERMIT COMMUNITY DEVELOPMENT Permit #: SWR2012 -00026 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/22!2012 Parcel: 1 S126CA01000 • Jurisdiction: Tigard Site address: 9009 SW HALL BLVD 115 Project: Sport Clips Subdivision: VASHINGTON SQUARE ESTATES NO. Lot: 108 Project Description: .6 EDU increase. Contractor: Owner: CAFARO NORTHWEST PARTNERSHIP PO BOX 422 FLORHAM PARK, NJ 07932 PHONE: PHONE: FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 02/22/2012 $2,700.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: 3 Number of Dwelling Units: .6 • Total $2,700.00 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 1.800.332.2344. Issued By: ile Permittee Signature: — S, �` y • 3 9.4175 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 job site at the time of each inspection. „ - Accumulative Sewer Tally a Tenant Name: SPORT CLIPS SWR # SWR2012 -00026 TIGARD Site Address: 9009 SW HALL BLVD PLM # PLM2012 -00035 Parcel #: 1S126CA01000 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 /Showcr 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 1 2 1 2 - 3 inch 5 0 0 0 0 0 - 4 inch 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 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: - Iav /Bar - Non -Food Related 2 0 0 1 2 1 2 - Bradley 5 0 0 0 0 0 - Com /Serv/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 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 3 _ 10 3 10 Current Fixture Value 10 divided by 16 = 0.6 Current EDU 1 EDU = $4,500.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 10 divided by 16 = 0.6 over (under) $ 2,700.00 Enter EDU Change Here 0.6 Notes: Authorized Name /Signature: BRANDEN TAGGART X2449 Date: 2/17/2012 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- 4500.xls 01/18/12