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Permit V CITY OF TIGARD SEWER CONNECTION PERMIT 1111 COMMUNITY DEVELOPMENT Permit#: SWR2013-00174 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2013 Parcel: 2S 113AB00600 Jurisdiction: Tigard Site address: 16165 SW 72ND AVE Project: CCK Restaurants LLC Subdivision: COUNCIL VIEW ACRES(LOTS 21-44) Lot: 30 Project Description: .13 EDU increase Contractor: Owner: PACIFIC REALTY ASSOCIATES LP ATTN: N PIVEN 15350 SE SEQUOIA PKWY#300 PORTLAND, OR 97224 PHONE: PHONE: FAX: • FEES Description Date Amount Specifics: Sewer Connection Fee 08/05/2013 $624.00 Type of Use: COM Class of Work: ALT Install Type: Building Sewer Fixture Units: Number of Dwelling Units: .13 Total $624.00 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 - •- •- or more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cen r. Those rules - - set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to v UNC by calling 503.232. •= • 1.800.332.2344. -sued By: \ i�, / Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection te. 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 IN C v '1'cnant Namc: CCK Restaurants SWR# 2013-00174 Site Address:'16165 SW 72nd Ave PI Al # 2013-00267 TIGARD Parcel#:'2S 113AB00600 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value count capped#5 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 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eve Wash 1 0 0 0 0 0 Floor Drain/Sink: -2 inch 2 0 0 0 0 0 -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 I-IP) 32 0 0 0 0 0 - Industrial (over 5 1-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: 7 -Lav/Bar-Non-Food Related 2 0 0 1 2 1 2 -Bradley 5 0 0 0 0 0 -Com/Sery/Util-Food Related 3 0 0 0 0 0 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 I DU Credit 0 TO•I'A1 S 0 0 0 0 1 2 1 2 Current Fixture Value 2 divided by 16= 0.125 Current EDU• 1 EDU= $4,800.00 Previous Fixture Value 0 divided by 16= 0.000 Previous EDU Change 2 divided by 16= 0.125 over (under) S 624.00 Enter EDU Change Here! 0.130 Notes: Authorized Name/Signature:'Debbie Adamski Date:! 8/5/2013 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\Sewer I'allyShcct_481111._117111 I3.xlsx