Permit (153) CITY OF TIGARD SEWER CONNECTION PERMIT
$ COMMUNITY DEVELOPMENT Permit#: SWR2018 00038
t-t ,ply L 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/29/2018
Parcel: 2S102AA00490
Jurisdiction: Tigard
Site address: 12085 SW HALL BLVD 130
Project: The Good Cake Bakery Subdivision: None
Project Description: .07 EDU increase: APPLIED.06 CREDITS FROM PLM2013-00070 TO A.13 INCREASE IN EDU'S. Lot: None
Contractor:
Owner: HALL STREET CROSSING LLC
BY MR&MRS ROGER W TOM
8067 SW RIGERT COURT
BEAVERTON, OR 97007
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee
01/29/2018 $385.00
Type of Use: COM
Class of Work: ALT
Install Type: Building Sewer
Fixture Units:
Number of Dwelling Units: .7
Total $385.00
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 rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: •ermittee Signature:
Call 13.6 •.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 the pr
Approved plans are required on the job site at the time of each inspection.
Accumulative Sewer Tally
a Tenant Name: THE GOOD CAKE BAKERY SWR# SWR2018-00038
TI G A R D Site Address: 12085 SW HALL BLVD PLM# PLM2018-00042
Parcel#: 2S102AA00490
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 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 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 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
Living Unit 16 0
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 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
Urinal 6 0 0
0 0 0 0
Previous EDU Count 0
0
Capped EDU Credit 0.06
0.96
TOTALS 0 0 0 0 1 2 1
1.04
Current Fixture Value 1.04 divided by 16= 0.065 Current EDU 1 EDU= $5,500.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change 1.04 divided by 16= 0.065 over (under) $ 385.00
Enter EDU Change Here 0.070 *
*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: 1/29/18 APPLIED.06 CREDITS FROM PLM2013-00070.
Authorized Name/Signature: BRANDEN TAGGART X2449 Date: 1/29/2018
Building Division
IN
ote: 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_5500_070117.xlsx
Accumulative Sewer Tally
III = Tenant Name:Arellanos Market***CREDITS*** SWR#N/A
Site Address: 12085 SW Hall Blvd PLM# 2013-00070
TIGARD
Parcel#: 2S 1 02AA00490
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 0 0 0
-Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 1 1 0 -1 -1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink: -2 inch 2 0 0 0 0 0
-3inch 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 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
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/Utd-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 EDU Credit 0
TOTALS 0 0 1 1 0 0 -1 -1
Current Fixture Value -1 divided by 16= -0.063 Current EDU 1 EDU= $4,665.00
Previous Fixture Value 0 divided by 16= 0.000 Previous EDU
Change -1 divided by 16= -0.063 over (under) $ (279.90)
Enter EDU Change Here -0.060
Notes: CREDITS. 1/29/18:CREDITS APPLIED IN FULL TO SW112018-00038. BT.
Authorized Name/Signature: Debbie Adamski Date: 2/28/2013
Building Division
INote: 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-4665.xls 07/01/12