Permit C ITY OF TI GARD SEWER CONNECTION PERMIT
t1k DEVELOPMENT SERVICES PERMIT #: SWR2001 -00311
�� � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/5/01
SITE ADDRESS; 15705 SW 72ND AVE PARCEL: 2S112DC -00100
SUBDIVISION: OREGON BUS. PARK III ZONING: I -L
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: GOLF MANUFACTURING
USA NO: FIXTURE UNITS: 9
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .6 EDU increase. Previous EDU's = 8.2 for a total of 131.2 fixture values. This permit adds 9
fixture values for a new total of 140.2 fixture values or 8.8 EDU's.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 PRMT CTR 12/5/01 $1,380.00 27200100000
Total $1,380.00
Phone:
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. 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
- / , c - . 4‘ 4---
ued by: Il •_,1'�� k Permittee Signature:
Call (503) 639 75 by 7:00 P.M. for an inspection needed thert business day
Accumulative Sewer Tally
Tenant Name: Golf Manufacturing This SWR# 2001 -00311
Address: 15155 SW 72nd Ave This PLM# 2001 -00610
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 1 1 1 1
Floor Drain /Sink - 2 inch 2 0 0 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 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 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- 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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 8.2 131.2 131.2
Capped EDU Credit 0
TOTALS 0 131.2 0 0 4 9 4 140.2
Current Fixture Value 140.2 divided by 16 = 8.8 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 131.2 divided by 16 = 8.2 Previous EDU
Change 9 divided by 16 = 0.6 over (under) $ 1,380.00
Enter EDU Change Here 0.6
HISTORY
Notes: PLM #?001 -00594 EDU# 5 SWR# )01 -00300
PLM# EDU# SWR#
C#,
EDU# SWR#
N � �h11 d - — :/IL. _ 1 , Date: l/ p '9 /y
Signature of pe.- .n that calculated this . Ily sheet and date pe med is req !red