Permit CITY OF TIGARD SEWER CONNECTION PERMIT
s COMMUNITY DEVELOPMENT Permit: SWR2014-00083
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/27/2014
Parcel: 1 S 135AB01004
Jurisdiction: Tigard
Site address: 10220 SW GREENBURG RD 100
Project: Coffee Renaissance Subdivision: METZGER,TOWN OF Lot: 9
Project Description: .13 EDU increase
Contractor: Owner: LINCOLN CENTER LLC
BY SHORENSTEIN PROPERTIES LLC
555 CALIFORNIA ST 49TH FL
SAN FRANCISCO,CA 94104
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/26/2014 $637.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .13
Total $637.00
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 rule - - set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a ..y of the rules or direct questions
to OUNC by calk,. 503.232. 987 or 1.800.332.2344.
Issued By: . ` _4` -.-/ Permittee Signature: ./ Airir
Call 503.639.4175 by 7:00 a.m.for the next available inspection d:
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
.74 4 Tenant Name: Coffee Renaissance SWR# 2014-00083
Site Address: 1022u S\V(irccnburg Rd#100 PLM# 2014-00237
Parcel #: 1S135AB01004
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s ,aloe count .iddcd# added value n,tal #s n ual values
Baptisery/Font 4 0 0 0 0 (I
Bath: -Tub/Shower 4 0 0 0 0 0
-Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash: -I ach Stall 6 0 0 0 0 0
-Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator I 0 0 0 0 0
Dishwasher: -Commercial 4 0 0 0 0 11
-Domestic 2 0 0 0 0 1)
Drinking Fountain I 0 0 0 0 0
Lye Wash I 0 0 0 0 (1
Floor Drain/Sink: -2 inch ' 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 3/4 111') 16 0 0 0 0 0
-Commercial(to 5 I IP) .3 2 0 0 0 0 0
-
-Industrial(over 5 I I I 42 0 0 0 0 0
Ice Machine/Refrigerator Drain I 0 0 0 0 lI
-
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 0 0 0
-Bradley 5
II
0 0 0 0
-Com/Sery/Util-Food Related 3 II 0 0 0 0
Swimming Pool Filter I 0 0 0 0 0
Washer-Clothes 6 0 0 0 0 0
Water Extractor 6 U 0 0 0 0
Water Closet-Toiler 6 u 0 0 0 0
Urinal 6 0 U 0 0 0
Previous VDU Count 0 0
Capped EDIT Credit 0
TOTALS 0 0 0 0 1 _ 1 _ 2
(:urrcut Fixture Value 2 divided by 16= 0.125 Current I flU 1 EDU = $4,900.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 2 divided by 16= 0.125 over (under) $ 637.00
Enter EDU Change Here 0.130
Notes:
Authorized Name/Signature: Debbie.Adamski Date: 8/25/2014
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:\Huilding\Sewer Tally\Sewer fallyShcet_49(N)._070114.xlsx
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