Permit CITY OF TIGARD
SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2002 - 00249
`�" `' 1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/18/02
SITE ADDRESS; 11505 SW HALL BLVD PARCEL: 1S135DA -01400
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: BRAHMA PREMENANDA
USA NO: FIXTURE UNITS: 103
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 6.4 EDU's for new temple.
Owner:
FEES
BRAHMAPREMANANDA ASHRAM/TEMPLE Type By Date Amount Receipt
11515 SW HALL BLVD
TIGARD, OR 97223 PRMT CTR 9/18/02 $14,720.00 27200200000
INSP CTR 9/18/02 $45.00 27200200000
Phone: Total $14,765.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 24 1987
Issued : A , : , _ �j� r Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally 1
Tenant Namerahma Premenanda This SWR # 2002 -00249
Site Address: 11515 SW Hall Blvd This PLM# 2002 -00011
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 1 2 1 2
Drinking Fountain 1 0 0 2 2 2 2
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 9 18 9 18
- 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 6 , 12 6 12
- Bradley 5 0 0 0 0 0
- Commercial 3 0 • 0 3 9 3 9
- 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 8 48 8 48
Urinal 6 0 0 2 12 2 12
Previous EDU Count 0 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 31 103 31 103
Current Fixture Value 103 divided by 16 = 6.4 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
, Change 103 divided by 16 = 6.4 over (under) $ 14,720.00
Enter EDU Change Here 6.4
HISTORY
Notes: New construction PLM# EDU# SWR#
PLM# EDU# SWR#
/ PL C EDU# SWR#
Name: ' 1 F' 11■_: A '. Date: 0l /a — _.
— Signature of perso that calculated this tally sheet and date perfro ed is required
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