Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2002 -00291
III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/7/02
SITE ADDRESS; 15205 SW 74TH AVE PARCEL: 2S112DB -00600
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
TENANT NAME: MEYER SIGN
USA NO: FIXTURE UNITS: 70
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 4.4 EDUs. Previous EDU =O (new building) Installation of 70 fixture values = current EDU 4.4.
Owner: FEES
DENNY MEYER
7340 SW LANDMARK LANE Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connect 11/7/02 $10,120.00
[SWINSP] Swr Inspect 11/7/02 $45.00
Phone: 503- 620 -2086
Total $10,165.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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
I s ued by: / Permittee Signature:
Call (503)'639 -4175 by 7:00 P.M. for an inspection needed the next business- y
Accumulative Sewer Tally
Tenant Name: er,Sign This SWR# 2002 -00291
Site Address: 2.,3 SW 74th Ave This PLM# 2002 -0040
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 r r 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 3 6 3 6
- 3 inch 5 0 _ 0 0 0 0
- 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 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 r 0 5 10 5 10
- Bradley 5 r 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 r r 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 4 24 4 24
Urinal 6 0 0 4 24 4 24 .
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 18 70 18 70
Current Fixture Value 70 divided by 16 = 4.4 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 70 divided by 16 = 4.4 over (under) $ 10,120.00
Enter EDU Change Here 4.4
HISTORY
Notes:New building PLM# EDU# SWR#
( riu� (2 A Jietota.S PLM# EDU# SWR#
Flout- TO ( oN/g 1 LWC Pt M# EDU# SW
_ . l t 4. � /4 4 ._ Date: /1/, 4R-- - Signature of person that calculated this tally sheet and date perfro is required