Permit 4
CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 -00390
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/24/03
SITE ADDRESS; 09430 SW CORAL ST 150 PARCEL: 1S126DC-04400
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -
BLOCK: LOT: 007 JURISDICTION: TIG
TENANT NAME: MARTIN OFFICE BUILDING
USA NO: FIXTURE UNITS: 3
CLASS OF WORK: ADD DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .2 EDU increase. Previous fixture values = 83.2, this permit adds 3, for new total of 86.2 fixture
values or 5.4 EDU's, for an increase of .2 EDU's.
Owner:
FEES
RENAISSANCE DEVELOPMENT
1672 SW WILLAMETTE FALLS DR. Description Date Amount
[SWUSA] Swr Connect 11/24/03 $480.00
[SWUSA] Swr Connect • 11/24/03 $0.00
Phone: 503 -557 -8000
Total $480.00
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
lr� / �` .
Iss - d by: ;IT �` - �Z/' Permittee Signature: �` � ie
Call ( % ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
_ Accumulative Sewer Tally Parcel # 1s126dc -04400
Tenant N he: Office Building This SWR #2003 -00390
Site Address: 9430 SW Coral St #150 This PLM# 2003 -00602
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s r 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 0 0 0
- 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 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 5.2 83.2 83.2
Capped EDU Credit 0
TOTALS 0 83.2 0 0 1 3 1 86.2
Current Fixture Value 86.2 divided by 16 = 5.4 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 83.2 divided by 16 = 5.2 Previous EDU
Change 3 divided by 16 = 0.2 over (under) $ 480.00
Enter EDU Change Here 0.2
Notes: 5.2 EDU's per Jairrae '�
• S' nature: ,t).. ' L J k_xd- ' Date: ///l4-
B ' ding Division
Note: The property owner s - all 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.xls 11/19/03