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Permit (19) .• CITY OF TIGARD SEWER CONNECTION PERMIT r te. DEVELOPMENT SERVICES PERMIT #: SWR2003 -00061 '• II 13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2120/03 SITE ADDRESS; 13727 SW PACIFIC HY 150 PARCEL: 2S103DD -00400 W SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG TENANT NAME: SUBWAY - USA NO: FIXTURE UNITS: 22 CLASS OF WORK: ALT DWELLING UNITS: TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: 1 Owner: FEES CB RICHARD ELLIS PROPERTY MANAGER Description Date Amount 1300 SW FIFTH STE 2600 [SWUSA] Swr Connect 2/20/03 $3,220.00 PORTLAND, OR 97201 [SWUSA] Swr Connect 2/20/03 $0.00 Phone: 503 - 221 -4810 Total $3,220.00 Contractor: Phone: Reg #: Required Inspections This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm ued by: k_ - 04/1 ' • Perm S ' I 1'I� Call (503) • - • -4175 by 7:00 P.M. for an inspection needed the rxt business day Accumulative Sewer Tally Tenant Name: Subway This SWR;~ 2003 -00061 Site Address 13727 SW Pacific Hwy #150 This PLM# 2003 -00051 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s 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 2 4 2 4 - 3 inch 5 0 0 0 0 0 - 4 inch 6. 0 0 0 0 0 - Car Wash Dr 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) 48 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 - Bar /Lavatory 2 0 0 3 6 3 6 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 2 6 2 6 - Service 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 1 6 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 7.6 121.6 121.6 Capped EDU Credit 0 TOTALS 0 121.6 0 0 8 22 8 143.6 Current Fixture Value 143.6 divided by 16 = 9.0 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 121.6 divided by 16 = 7.6 Previous EDU Change 22 divided by 16 = 1.4 over (under) $ 3,220.00 Enter EDU Change Here 1.4 HISTORY Notes: PLM# 2002 -00358 EDU# 7.6 SWR# 2002 -00282 PLM# 2002 -00336 EDU# 6.3 SWR# 2002 -00253 # per acct, 9/9/02 EDU# 3.8 SWR# ame: 1.1 ‘4 . r 013,1 is Date: 43043 Signature o person that calculated this tally sheet and date perfromed Is required