Permit n CITY OF TIGARD SEWER CONNECTION PERMIT
1 1 1 1 2 ' COMMUNITY DEVELOPMENT Permit #: SWR2013 -00128
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2013
Parcel: 1 S 135BA00102
Jurisdiction: TIGARD
Site address: 10124 SW WASHINGTON SQUARE RD
Project: Strada Street Food of Italy Subdivision: OAKBURG Lot: 9
Project Description: 3.13 EDU increase
Contractor: Owner: PPR SQUARE TOO LLC
PO BOX 847
CARLSBAD, CA 92018
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/15/2013 $14,601.45
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 3.13
Total $14,601.45
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 spended . ore the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Cent Those rules are .et forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may •• - in a copy of the rules or direct questions
to O NC by calling 503.232.1 • : .r 1 :'0.332.2344.
Is ued By: j Permittee Signat ) f/ � $
Call 503.639.4175 by 7:00 a.m. for the next available inspe •.n 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
p 'Tenant Name: Strada Street Food of Italy SWR # 2013 -00128
TIGARD Site Address: 10124 SW Washington Square Rd PI Al # 2013 -00182
Parcel #: 1S135BA00102
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped #5 value count added # added value total #s total 'values
Baptistry /Font 4 0 0 0 0 0
Bath: -'l'ub /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 1 4 1 4
- 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 11 22 11 22
- 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 1 -IP) 16 0 0 0 0 0
- Commercial (to 5 I -1P) 32 0 0 0 0 0
- Industrial (over . 5 I -1P) 42 0 0 0 0 0
Ice \lachine /Refrigerator Drain 1 0 0 1 1 1 1
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:
- l,av /Bar - Non -Food Related 2 0 0 4 8 4 8
- Bradley 5 0 0 0 0 0
- Com /Sery /Util - Food Related 3 0 0 7 21 7 21
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 4 24 3 18 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 . 0 4 24 27 74 23 50
Current Fixture Value 50 divided by 16 = 3.125 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 50 divided by 16 = 3.125 over (under) S 14,601.45
Enter EDU Change Here 3.130
Notes:
Authorized Name /Signature: ,Debbie Adamski Date: ' 6/18/2013
Building Division
Note: The property owner shall retain the ORIGINA], sewer tally record. I f 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 \Suwer 'rally \Sewer'I ' allvSheet- 4665.xls u7 /111 /12