Permit CITY OF TIGARD SEWER CONNECTION PERMIT
11 s COMMUNITY DEVELOPMENT Permit#: SWR2014-00087
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/08/2014
T t G A lip 9 Parcel: 1 S134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 700
Project: JetSet Coffee Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: .13 EDU increase
Contractor: Owner: ROBINSON,CONSTANCE A
BY KILLIAN PACIFIC LLC
500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/08/2014 $637.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $637.00
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 obtain a copy of the rules or direct questions
to OUNC by calling 503.23 •87 o .800.332.2344.
Issued By: i �C'— Permittee Signature: / /i1
Call 503.639.4175 by 7:00 a.m.for the next available inspection daW.
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.
77 1
Tenant Name: lctSct Coffee Accumulative Sewer Tally SWR# 2014-00087
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Site Address: 10115 SW Nimbus#700 PLM# 2014-00290
Parcel#: 1S 134AA01900
l'ixturc \ .iliu I'reviiuu Previous Credits Capped Fixture Fixture New New
# value count capped#s value 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/Whir >ol 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 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 1 2 1 2
-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 (I 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 u 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 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 U 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer-Clothes 6 n 0 0 0 0
Water Extractor 6 0 0 0 0 0
WaterCloset-Toilet 6 u 0 0 0 0
Urinal 6 u 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 _ 0 1 2 1 2
Current Fixture Value 2 divided by 16= 0.125 Current IsDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
P Change 2 divided by 16= 0.125 over (under) S 63-.00
Enter EDU Change Here 0.130
Notes:
Authorized Name/Signature: Debbie Adamski Date: 8/26/2014
Building Division
ote: The property owner shall retain the ORIG IN.31.sewer tally record. If credits exist,this document will serve as a voucher which must be
•ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
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