Permit 71 a CITY OF TIGARD SEWER CONNECTION PERMIT
° ' COMMUNITY DEVELOPMENT PERMIT #: SWR2008 - 00090
DATE ISSUED: 6/9/2008
TIGARD
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S12600 -00300
_ SITE ADDRESS: 09567 SW WASHINGTON SQUARE RD ZONING: C -G
SUBDIVISION: SINEMINGTON SQUARE LOT: JURISDICTION: TIG
PROJECT: FRED MEYER JEWELERS
Project Description: .2 EDU Increase.
TENANT NAME: FRED MEYER JEWELERS
CWS NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 0.2
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
WASHINGTON SQUARE LLC FEES
BY THE MACERICH COMPANY Description Date Amount
9585 SW WASHINGTON SQUARE RD
TIGARD, OR 97223 [SWUSA] Sewer Connection Fee 6/9/2008 $560.00
Phone: Total $560.00
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.
. Iss ed by: ; dik ' Permittee Signatu : • - � • ! , !of r , _
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 requited on the job site at the time of each inspection.
.. it Accumulative Sewer Tally Parcel # 1S12600
Tenant Name: FRED MEYER JEWELERS This SWR# SWR2008 - 00090
Site Address: 9567 SW WASHINGTON SQUARE RD. This PLM# PLM2008 - 00256
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
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 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 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 0 0 0
- Service 3 0 0 1 3 1 3
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 1 3 1 3
Current Fixture Value 3 divided by 16 = 0.2 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 3 divided by 16 = 0 2 over (under) $ 560 00
Enter EDU Change Here 0.2
Notes:
Authorized Name /Signature: Branden Taggart Date: 6/6/2008
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 \Sewer 1'allySheet -2008 xls 06/30/07