Permit CITY OF TIGARD SEWER CONNECTION PERMIT
11 • COMMUNITY DEVELOPMENT Permit#: SWR2014-00081
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2014
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10114 SW WASHINGTON SQUARE RD
Project: Pieology Subdivision: OAKBURG Lot: 9
Project Description: 2.5 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 08/28/2014 $12,250.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 2.5
Total $12,250.00
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 obta'• = copy or t fact q --io•
to OUNC b ling 51 232. •:7 or 1.800.332.2344. /
Issu By: ,i Permittee Signature: •
�0i�
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.
IN Accumulative Sewer Tally
e Tenant Name: Pieology SWR# 2014-00081
TIGARD Site Address: 10114 SW Washington Square Rd PLM# 2014-00253
Parcel#: 1S135BA00102
Fixture \,il(1c Previous Previous Credits Capped Fixture fixture New New
# value count capped#. )clue count added t added value total#s total values
Baptisery/Font 4 u 0 0 0 0
Bath: -Tub/Shower 4 0 U 0 0 0
-Jacuzzi/Whirlpool 4 U U 0 0 0
Car Wash: -Each Stall 6 0 U 0 0 0
-Drive through 16 U U 0 0 0
Cuspidor/Water Aspirator 1 U U 0 0 0
Dishwasher: -Commercial 4 U U 0 0 0
-Domestic 2 U U 0 0 0
Drinking Fountain I U 0 0 0 0
Eye Wash 1 0 U 0 0 0
Floor Drain/Sink: -2 inch 2 0 2 4 0 -2 -4
-3 inch 5 0 0 lU 50 10 50
-4 inch 6 0 U 0 0 0
-Car Wad 6 U 0 0 0 0
Garbage Disposal:
-Domestic(to 3/411P) 16 0 0 0 0 0
-Commercial(to 5 HP) 32 0 11 0 0 0
- Industrial(over 5 11P) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 11 1 1 1 1
Living Unit 16 U U 0 0 0
Oil Sep(Gas Station) 6 n o 0 0 U
Rec.Vehicle Dump station 16 0 U 0 0 0
Shower: -Gang(per head) 1 U U 0 0 0
-Stall 2 I I U 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 2 4 0 -2 -4
-Bradley 5 0 U 0 0 0
-Com/Serv/Util-Food Related 3 0 0 3 9 3 9
Swimming Pool Filter 1 0 U 0 0 0
Washer-Clothes 6 0 (1 0 0 0
Water Extractor 6 0 (I 0 0 11
Water Closet-Toilet 6 0 2 12 0 -2 -12
Urinal 6 U 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit U
TOTALS 0 0 6 20 14 60 8 40
Current Fixture Value 40 divided by 16= 2.500 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 40 divided by 16= 2.500 _ over (under) S 12,250.00
Enter EDU Change Here 2.500
Notes: Per CWS,the 3-compartment sink&the food prep are not included in calculation as they drain into 3"floor sink.
Authorized Name/Signature: Debbie Adamski Date: 8/4/2014
Building Division
Note: The property owner shall retain the ORIGIN:11,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_491 U._U7U114.xlsx