Permit CITY OF TIGARD SEWER CONNECTION PERMIT
Ila COMMUNITY DEVELOPMENT �, Permit SWR2015-00246
•
T IGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/29/2016
'
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10154 SW WASHINGTON SQUARE RD
Project: Pier 1 Imports Subdivision: OAKBURG Lot: 9
Project Description: 2.06 EDU increase.4/15/16,REPRINTED to correct address from 10144 to 10154 SW Washington Square Rd.
Contractor: Owner: PPR SQUARE TOO LLC
PO BOX 847
CARLSBAD, CA 92018
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/29/2016 $10,506.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 2.06
Total $10,506.00
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 calli.• :• .232.19: or 1.800.332.2344.
Issued By Permittee SignaturC
Call 503.639.4175 by 7:00 a.m.for the next available inspection: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.
p CITY OF TIGARD SEWER CONNECTION PERMIT
:11.11 ' COMMUNITY DEVELOPMENT Permit#: SWR2015-00246
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/29/2016
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10144 SW WASHINGTON SQUARE RD
Project: Pier 1 Imports Subdivision: OAKBURG Lot: 9
Project Description: 2.06 EDU increase
Contractor: Owner: PPR SQUARE TOO LLC
PO BOX 847
CARLSBAD, CA 92018
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/29/2016 $10,506.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 2.06
Total $10,506.00
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 rul•- or direct questions
to OUNCailing 53,232.19: or 1.800.332.2344. /
Issue By:
0\-...:../-
�� 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
- 'Tenant Name: Pier 1 Imports SWR# 2015-00246
Site.Address: 10144 SW Washington Square Rd PLM# 2015-00435
TI ARI)
Parcel#: 1S 1 35BA00z 1 02
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# _ added value total#s total values
Baptisery/Dont 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: -1?ach 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 2 2 2 2
I?ye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 2 10 2 10
-4inch 6 0 0 0 0 0
-Car Wash 6 0 0 0 0 0
Garbage Disposal:
-Domestic(to 3/4 IIP) 16 0 0 0 0 0
-Commercial(to 5 I IP) 32 0 0 0 0 0
-Industrial (over 5 I IP) 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 _ 3 6 3 6
-Bradley 5 0 0 0 0 0
-Cum/Sery/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 Ixtractor 6 0 0 0 0 0
Water Closet-Toilet 6 0 0 2 12 2 12
Urinal 6 0 0 0 _ 0 0
Previous IDU Count 0 0
Capped I:DV Credit 0
TOT,ALS 0 0 0 0 10 33 10 33
Current Fixture Value 33 divided by 16= 2.063 Current I:DU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 _ Previous I?DU
Change 33 divided by 16= 2.063 over (under) S 10,506.00
Enter EDU Change Here 2.060
*Round l:DUs to the nearest 1/100th: a count ending in.005 shall be rounded up to.01,and a count ending in.014 or less shall be rounded down to.01.
Notes:
Authorized Name/Signature: Debbie Adamski Date: 2/11/2016
Building Division
Note: The property owner shall retain the ORIGIN Al.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.
1:ABuilding\Sewer Tally\Sewer'TallyShcet_51uu_u7u115.xlsx
CITY OF TIGARD SEWER CONNECTION PERMIT
11111 :e COMMUNITY DEVELOPMENT Permit#: SWR2015-00246
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/29/2016
Parcel: 1 S135BA00102
Jurisdiction: Tigard
Site address: 10144 SW WASHINGTON SQUARE RD
Project: Pier 1 Imports Subdivision: OAKBURG Lot: 9
Project Description: 2.06 EDU increase
Contractor: Owner: PPR SQUARE TOO LLC
PO BOX 847
CARLSBAD, CA 92018
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 03/29/2016 $10,506.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 2.06
Total $10,506.00
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 wit 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 obtai• •py of •es or dir•ct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: •• mittee Signature:
.111./-_ i.1�_
Call 0 39.4175 by 7:00 a.m.for the next available insp•• ion date.
This permit card shall be kept in a conspicuous place on the job site til completion of the . oject.
Approved plans are required on the job site at the ti .• of each inspection.