Permit 1 V CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2014-00009
T!GA RO 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/10/2014
Parcel: 2S 101 AB01606
Jurisdiction: Tigard
Site address: 7357 SW BEVELAND RD 100
Project: Well&Good Coffee House Subdivision: HERMOSO PARK Lot: 17
Project Description: .19 EDU increase
Contractor: Owner: MIF LLC
7357 SW BEVELAND RD#200
TIGARD,OR 97223
PHONE
PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/10/2014 $912.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .19
Total $912.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Special odes and all other applicable
law. All work will be done in accordance with approved plans. This permit will expire if work is not .rte• within 180 days of issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rule. adop •. by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obt. n a 1)y of the rules or direct questions
to OUNC b ailing 503. 1987 or 1.800.332.2344.
Issued y: f / •,. AL A ` Permittee Signature: x
Call 503.639.4175 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.
71 ii Accumulative Sewer Tally
Tenant Name: Well&Good Coffee I louse SWR# 2014-00009
TIGARD Site Address: 7359 SW Beveland Rd PLM# 2014-00037
Parcel#: 2S101AB01606
Fixture Value Previous Previous Credits Gapped Fixture Fixture Nev.' New
# value count capped#s (,due count added# added value total#s total 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 ) 0 0 0 0 (I
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
-3inch 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 11
Living Unit 16 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:
-Lav/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Serv/Util-Food Related 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= 0.188 Current EDU 1 EDU= $4,800.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 3 divided by 16= 0.188 over (under) $ 912.00
Enter EDU Change Here 0.190
Notes:
Authorized Name/Signature: Debbie.\damski Date: 2/10/2014
Building Division
rote: 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\Sever Tally\SewerTallySheet_4800._070113.xlsx