Permit 711 p CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR2015-00111
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/16/2015
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9540 SW WASHINGTON SQUARE RD H15
Project: See's Candies Subdivision: VASHINGTON SQUARE ESTATES NO. Lot: S
Project Description: .94 EDU increase
Contractor: Owner: PPR WASHINGTON SQUARE LLC
PO BOX 847
CARLSBAD, CA 92018
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/16/2015 $4,794.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .94
Total $4,794.00
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 da s • issuance, or if
work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by •- •regon Utili 1 Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a c•• e rules or • ect questions
to OUN calling 50 .'_ .1•' or 1.800.332.2344.
Is ued By: 02*/„...emiiitiLiThis Permittee Signature: i��Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
permit card shall be kept in a conspicuous place on the job site until completio •f th• . oject.
Approved plans are required on the job site at the time of each inspe• io..
Si Accumulative Sewer Tally
'Tenant Name: See's Candies SWR# 201540111 PI
Site Address: 9540 SW Washington Square Rd .M# 2015-00304 :,
Parcel#: 1S128000300
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value count capped#s value count added# added value total#s total values
Baptiscry/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 O 0
Drinking Fountain 1 0 0 0 O 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3 inch 5 0 0 I 5 1 5
-4 inch 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 1 IP) 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 2 4 2 4
-Bradley 5 0 0 0 0 0
-Com/Sery/Util-Food Related 3 0 0 2 6 2 6
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 5 15 5 15
Current Fixture Value 15 divided by 16= 0.938 Current EDU 1 EDU= $5,100.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 15 divided by 16= 0.938 over (under) $ 4,794.00
Enter EDU Change Here 0.940 *
*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:
Authorized Name/Signature: Debbie Adamski Date: 9/15/2015
Building Division
rote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist,this document will serve as a voucher which must be
ubmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
1:\Building\Sewer Tally\ScwerTallySheet_5100_070115.xlsx