Permit (3) CITY OF TIGARD SEWER CONNECTION PERMIT
I COMMUNITY DEVELOPMENT Permit#: SWR2014-00086
T I G AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/03/2014
Parcel: 1S 1260000300
Jurisdiction: Tigard
Site address: 9589 SW WASHINGTON SQUARE RD B09
Project: Apple Store Subdivision: VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: 1.31 EDU increase
Contractor: Owner: PPR WASHINGTON SQUARE LLC
PO BOX 847
CARLSBAD,CA 92018
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/03/2014 $6,419.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.31
Total $6,419.00
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 adopt-. by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain •.y of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 5 by 7:00 a.m.for the next available inspe o .ate.
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
III 'r. Tenant Name: Apple Store SWR# 2014-00086
Site Address: 9589 S\\ Washington Square Rd B09 PLM# 2014-00287
Parcel#: 1s1260000300
Fixture A aluc I'r„u,.. I'rcvious Credits (.apped Fixture fixture New New
\Ague count capped#,. caluc count added,; added value total#s total 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 2 4 2 4
-3 inch 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 I IP) 16 0 0 0 0 0
-Commercial(to 5 I IP) 32 0 0 0 0 0
-Industrial(over 5 UP) 42 0 0 0 0 0
Ice Machine/Refrigerator Drain 1 0 0 0 0 0
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 II 0 0 0
Sink:
-Lav/Bar-Non-Food Related 2 0 2 4 3 6 1 2
-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 I I
Water Closet-Toilet 6 0 2 12 3 18 1 6
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 II
Capped EDU Credit 11
TOTALS 0 0 4 16 10 37 6 21
Current Fixture Value 21 divided by 16= 1.313 Current EDU 1 FM. = S4,900.011
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 21 divided by 16= 1.313 over (under) S 6,419.00
Enter EDU Change Here 1.310 __
Notes:
Authorized Name/Signature: Dcbbic.\damski Date: 8/26/2014
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 I'allySheet_4900._070114.xlsx