Permit CITY OF TIGARD SEWER CONNECTION PERMIT
f'! " COMMUNITY DEVELOPMENT Permit #: SWR2012 -00156
T f G A.R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012
Parcel: 1 S134BC00200
Jurisdiction: Tigard
Site address: 12160 SW SCHOLLS FERRY RD 100
Project: Berry Farm Yogurt Subdivision: WINDSOR PLACE Lot: 32
Project Description: .69 EDU increase
Contractor: Owner: GREENWAY CENTER LLC
ANA KALAKAUA CENTER
2155 KALAKAUA AVE #602
HONOLULU, HI 96815
PHONE PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/02/2012 $3,218.85
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .69
Total $3,218.85
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 ao•, of the rules or direct question
to OUNC by c- ' g • . .1987 • :00.332.2344.
Issued :y: /1// Permittee Signature: �``J Al -` '
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 th project.
Approved plans are required on the job site at the time of each inspection.
I Accumulative Sewer Tally
4
;`, 'Tenant Name: Berry Farm Yogurt SWR # 2012 -00156
F1trAAiy Site Address: 12160 SW Scholls Ferry Rd #100 PIN # 2012 -00184
Parcel #: 1S134BC00200
Fixture Value Previous 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 /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 1 2 1 2
- 3 inch 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 I -IP) 16 0 0 0 0 0
- Commercial (to 5 1 -IP) 32 0 0 0 0 0
- Industrial (over 5 l -IP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 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 /Scry /Util - Food Related 3 0 0 3 9 3 9
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
TOTAL S _ 0 0 0 _ 0 4 11 4 11
Current Fixture Value 11 divided by 16 = 0.688 Current EDU 1 EDU = $4,665.00
Previous Fixture Value 0 divided by 16 = 0.000 Previous EDU
Change 11 divided by 16 = 0.688 over (under) S 3,218.85
Enter EDU Change Here 0.690
Notes: Only counting (1) floor drain as the 3- compartment sink drains into it.
Authorized Name /Signature: Debbie Adamski Date: 7/2/2012
Building Division
r ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \ Building \Sewer Tally \Scwer 1'allyShcet -4500. xls 01/18/12