Permit (8) CITY TIGARD SEWER CONNECTION PERMIT
l DEVELOPMENT SERVICES PERMIT #: SWR2003 -00170
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/4/03
SITE ADDRESS; 11847 SW PACIFIC HWY PARCEL: 1S135DD -00800
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C - G
BLOCK: LOT: 022 JURISDICTION: TIG
TENANT NAME: XENON WEST
USA NO: FIXTURE UNITS: 88
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 5.5 EDU increase, previous fixture values were 32, this permit credits 8 and adds 96 for a new total
of 120 fixture values.
Owner: FEES
SANOKEE
375 NW GILMAN BLVD STE C -203 Description Date Amount
ISSAQUAH, WA 98027 [SWUSA] Swr Connect 6/4/03 $12,650.00
[SWUSA] Swr Connect 6/4/03 $0.00
Phone: 425 391 - 0570
Total $12,650.00
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
•
Is ued by: � � .? ;, !_ 7, /� Permittee Signature:
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the xt business day
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Accumulative Sewer Tally
Tenant Name: Xenon West This SWR # 2003 -00170
Site Address: 11847 SW Pacific Hwy This PLM# 2003 -00215
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.
I
- 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 3 6 3 6
- 3 inch 5 0 0 4 20 4 20
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 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 1 1 _ 1 1
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 1 2 6 12 5 10
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 . 3
- Service 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 1 6 6 36 5 30
Urinal 6 0 0 2 12 2 12
Previous EDU Count 2 32 32
Capped EDU Credit 0
TOTALS 0 32 2 8 25 96 23 120
Current Fixture Value 120 divided by 16 = 7.5 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 32 divided by 16 = 2.0 Previous EDU
Change 88 divided by 16 = 5.5 over (under) $ 12,650.00
Enter EDU Change Here 5.5
HISTORY
Notes: Per Allie, 2 EDU's PLM# EDU# SWR#
PLM# EDU# SWR#
( EDU# SWR
a me: r_ F ._ L L.�_L_ Date:
Signature o • - on that calculated Is tally sheet and date perfrome Is r qulred