Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2015-00003
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/20/2015
Parcel: 1 S135BD00200
Jurisdiction: Tigard
Site address: 9785 SW SHADY LN
Project: Starbucks Subdivision: ASHBROOK FARM Lot: 5
Project Description: 1.38 DU increase
Contractor: Owner: NORED, STANLEY D&AUDENE C
511 NE 21ST PL
CANBY, OR 97013
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/20/2015 $6,762.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.38
Total $6,762.00
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 calling . 232.1987 or 1.800.332.2344.
Issued y: Aik /40 , , Permittee Signature:
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
1111-or Tenant Name: Starbucks SWR# 2015-00003
Site Address: 9785 SW Shad% I.n PLM# 2015-00007
I I(,ARI)
Parcel#: 1S135BD00200
Fixture \aloe 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 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 (1
Dishwasher. -Commercial 4 0 0 1 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 6 12 6 12
-3 inch 5 0 0 0 0 0
-4inch 6 6 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 111') 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 I 0 0 I 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) I 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/U til-Food Related .i 0 0 7 21 7 21
Swimming Pool Filter I 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 2 32
TOTALS 0 0 _ 0 0 19 54 19 _ 22
Current Fixture Value 22 divided by 16= 1.375 Current I:DU 1 EDU= $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 22 divided by 16= 1.375 over (under) $ 6,762.00
Enter EDU Change Here 1.380
Notes: 1/15/15,per contractor all existing fixtures were removed and lines capped previously. UB was billing 2 DU's,so creditting for 2 DU's.
2 food prep sinks are indirect to floor sink,so floor sink removed from calculation.
Authorized Name/Signature: Debbie Adamski Date: 1/15/2015
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
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
l:\Building\Sewer Tally\Sever 1'allyShect_4900._070114.xlsx