Permit CITY TI GARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 -00381
chi DATE ISSUED: 10/30/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 10220 SW GREENBURG RD 540
PARCEL: 1 S 135AB -01004
SUBDIVISION: TWO LINCOLN - TOWN OF METZGER ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: PAXTON- MILLER
USA NO: FIXTURE UNITS: 3
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .2 EDU increase. Previous fixture units wer 145.6, this permit adds 3, for new total fixture total of
148.6.
Owner:
FEES
EOP LINCOLN, LLC
10260 SW GREENBURG RD Description Date Amount
SUITE 100 [SWUSA] Swr Connect 10/30/03 $480.00
PORTLAND, OR 97223 [SWUSA] Swr Connect 10/30/03 $0.00
Phone:
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
Issued • : 1 __ t ��iLl , i10 ( Permittee Signature: -
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• Accumulative Sewer Tally
tenant Name: Paxton- Miller This SWRt 2003 -00381
Bite Address: 10220 SW Greenburg Rd #540 This PLM# 2003 -00560
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 0 0 0
-3inch 5 0 0 0 0 0
-4inch 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 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 9.1 145.6 145.6
Capped EDU Credit 0
TOTALS 0 145.6 0 0 1 3 1 148.6
Current Fixture Value 148.6 divided by 16 = 9.3 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 145.6 divided by 16 = 9.1 Previous EDU
Change 3 divided by 16 = 0.2 over (under) $ 480.00
Enter EDU Change Here 0.2
HISTORY
Notes: PLM# EDU# SWR#
Per Jaime, 9.1 EDU's PLM# EDU# SWR#
PLM# EDU# SWR#
ame: 1 ,, q .+ — 01(9--1/110/12 Date: /0/9.72.3
Signature • f person that calculated this tally sheet and date perfromed is required