Permit (51) CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT
Permit#: SWR2016 00238
Date Issued: 09/06/2016
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 25101 BA00101
Jurisdiction: Tigard
Site address: 7500 SW DARTMOUTH ST 110
Project: Joy Teriyaki Subdivision: None Lot: None
Project Description: 1.56 EDU increase
Contractor: Owner: WAL-MART REAL ESTATE BUSINESS TR
BY PROPERTY TAX DEPT STORE 5935-00
PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/06/2016 $7,956.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: 1.56
Total $7,956.00
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. ose rules .reset forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the r les or direct questions
to 0. C by calling 503.232. 8 800.332.2344. 411, /
I-sued By: , Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection
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: JoyTeriyaki
• m SWR# 2016-00238
Site Address: 7500 SW Dartmouth St PLM# 2016-00355
TIGARD
Parcel#: 2S 101 BA00101
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 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 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 2 4 2 4
-3 inch 5 0 0 1 5 1 5
-4inch 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:
-Lay/Bar-Non-Food Related 2 0 0 0 0 0
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 4 12 4 12
Swimming Pool Filter 1 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 8 25 8 25
Current Fixture Value 25 divided by 16= 1.563 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 25 divided by 16= 1.563 over (under) $ 7,956.00
Enter EDU Change Here 1.560 *
*Round EDUs 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: 2"floor sink is not included in calculation as there is a food related sink draining into it-Per CWS only(1)of these fixtures is to be counted.
Authorized Name/Signature: Debbie Adamski Date: 7/6/2016
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\SewerTallySheet_5100_070115.xlsx