Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2014-00071
T[GA i2 D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/02/2014
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 30
Project: 'chi Teriyaki Subdivision: FREWING'S ORCHARD TRACTS Lot: 15
Project Description: 1.69 EDU increase
Contractor: Owner: ROIC OREGON LLC
8905 TOWNE CENTRE DR, STE 108
SAN DIEGO,CA 92122
PHONE
PHONE:
FAX:
FEES
Description Date Amount
Specifics:, Sewer Connection Fee 09/02/2014 $8,281.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.69
Total $8,281.00
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 e Oregon Utility Notifica
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy • h= r -s or direct qu-. i• s
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ` _ . 1-
Call 503.639.4175 by 7:00 a.m.for the next available inspectio. date.
This permit card shall be kept in a conspicuous place on the job site until c-•mpletion of the project.
Approved plans are required on the job site at the time of each inspection.
1111 ri Accumulative Sewer Tally
Tenant Name: Ichi Teriyaki SWR# 2014-00071
TIGARD Site Address: 13500 SW Pacific Hwy#30 PIN# 2014-00246
Parcel#: 2S102CC00500
Fixture \,iluc I'rcvious Previous Credits Capped Fixture Fixture New New
# %aloe count capped#s value 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 I 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 I 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 2 4 2 4
-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 3/4111) 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 1 1 1 1
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:
-l.av/Bar-Non-Food Related 2 0 0 3 6 3 6
-Bradley - 0 0 0 0 0
-Com/Serv/Util-Food Related 3 0 0 2 6 2 6
Swimming Pool Filter 1 0 0 0 II 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 6 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 10 27 10 27
Current Fixture Value 27 divided by 16= 1.688 Current EDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 27 divided by 16= 1.688 _ over (under) $ 8,281.00
Enter EDU Change Here 1.690
Notes:
Authorized Name/Signature: Debbie Adamski Date: 7/29/2014
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 l'allySheet_4910._1170114.xls x