Permit CITY OF TIGARD SEWER CONNECTION PERMIT
F1 I COMMUNITY DEVELOPMENT Permit#: SWR2014-00114
T t GA R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/08/2014
Parcel: 2S102CC00500
Jurisdiction: Tigard
Site address: 13500 SW PACIFIC HWY 17
Project: Mizumi Buffet Subdivision: FREWING'S ORCHARD TRACTS Lot: 15
Project Description: Remodel existing restaurant. .75 EDU increase.
Contractor: Owner: ROTC OREGON LLC
8905 TOWNE CENTRE DR, STE 108
SAN DIEGO, CA 92122
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/05/2014 $3,675.00
Type of Use: COM
Class of Work: ALT
Install Type:
Fixture Units:
Number of Dwelling Units: .75
Total $3,675.00
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 iules_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 b ailing 503.23 . 187 or 1.8114 332.2344.
Issue By: .rte Permittee Signature: 1#174��"r
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.
Accumulative Sewer Tally
r
~ Tenant Name: Mizumi Buffet SWR# 2014-00114_REV1
TI c n tt 13 Site Address: 13500 SW Pacific Hwy#17 PLM# 2014-00352
Parcel#: 2S102CC00500
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptisery/Font 4 0 0 I 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 0 0 0
-3inch 5 0 0 1 5 1 5
-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 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 2 4 2 4
-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 O
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 4 12 4 12
Current Fixture Value 12 divided by 16= _ 0.750 Current LDU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 12 divided by 16= 0.750 over (under) $ 3,675.00
Enter EDU Change Here 0.750
Notes: 11/5/14:Removed(1)ice machine and(1)food-prep sink from scope of work per Wei Liang Chen. BT.
Authorized Name/Signature: Debbie Adamski Date: 10/29/2014
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
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
1:\Building\Sewer Tally\SewerTallySheet_4900._070114.xlsx
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