Permit /0 709 Ene?
C ITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2004 -00199
R! � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/26/2004
SITE ADDRESS; 11535 SW PACIFIC HWY PARCEL: 1S136AD -04000
SUBDIVISION: VILLA RIDGE ZONING: C -
BLOCK: LOT: 007 JURISDICTION: TIG
TENANT NAME: HALAL MEAT & MEDITERRIAN
USA NO: FIXTURE UNITS: 21
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.3 EDU increase.
Owner: FEES
SMITH, EDITA M
833 NW 170TH DR Description Date Amount
BEAVERTON, OR 97006 [SWUSA] Swr Connectic 7/26/2004 $3,250.00
[SWUSA] Swr Connectic 7/26/2004 $0.00
Phone:
Total $3,250.00
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"
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 -0100. You
may obtai • •ies of these rules or direct questions to OUNC by calling (503) 246 -6699.
Issu: d by: / O 4 ' Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busines ay
•
CITY TIGARD SEWER CONNECTION PERMIT
I DEVELOPMENT SERVICES PERMIT #: SWR2004 -00199
Att- . . � � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/26/2004
SITE ADDRESS; 11535 SW PACIFIC HWY PARCEL: 1S136AD -04000
SUBDIVISION: VILLA RIDGE ZONING: C -
BLOCK: LOT: 007 JURISDICTION: TIG
TENANT NAME: HALAL MEAT & MEDITERRIAN
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: EDU increase.
Owner: FEES
SMITH, EDITA M
833 NW 170TH DR Description Date Amount
BEAVERTON, OR 97006 [SWUSA] Swr Connectic 7/26/2004 $3,250.00
[SWUSA] Swr Connecfic 7/26/2004 $0.00
Phone:
Total $3,250.00
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"
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 • - 411-0100. You
may obtain copies of these rules or direct questions to OUNC by calling (503) 246-669'
Issued by•'� / s / P ermittee Signature: ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
k
Accumulative Sewer Tally Parcel # 1:46tC fit,
TAn rtt G e Ha M e01 a z Y� a yA m This SWRd 1 1 s ,
f a sk �, � itItfi�� '. 61,4W a �`�a> l=sa .,. .. This PLM# � Q : ...:.... ': ,.V
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 i ,,,r;°j 0 r n 0 x k 0 0 0
Bath Tub /Shower 4 0 r`7 " 0 ��� ' 0 0 0
- Jacuzzi/Whirlpool 4 ,�, 0 0 0 0 j; 0 0 0
Car Wash - Each Stall 6 d int;» i 0 I 0 UIR 0 0 0
- Drive through 16 0 w 0 . � , „1 0 0 0
Cuspidor /Water Aspirator 1 7:„704,:, 0 5a e 0 twAst o o o
Salt v � t y `fin' �',�
Dishwasher - Commercial 4 0 „.,4 0 orkty 4 1 4
- Domestic 2 0
Drinking Fountain 1 , ,? 0 0 n > k 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 T „r'1. 0 # fi x 0 g r, ; s ; 4 2 4
3 inch 5 e` 0 r4k = l 0 ti ��':"- 0 0 0
- 4 inch 6 ,� . 0 41:',A1 0 y 0 0 0
- Car Wash Drn 6 , , ,, 0 a 8 � ',-.- m 0 > , , ° 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 , � 0� 0 , � 0 0 0
- Commercial (to 5 HP) 32 ',''''''it 0 irl 0 l,% 0 0 0
- Industrial (over 5 HP) 48 0�� 0 illOil
Ice Machine /Refrigerator Drain 1 ;: :, 0 0 k � 1 1 1
Oil Sep (Gas Station) 6 �, ?, ,, 0 ' 0 ,w 0 0 0
Rec. Vehicle Dump station 16 ' � 0 �" � 0 -t 0 0 0
Shower - Gang (per head) 1 0 �. t 0 .1, 3 0 0 0 CSVg
- Stall 2 f4.. « 0 `
Sink - Bar /Lavatory 2 0 ; r,: 0 6,, _r : 0 0 0
- Bradley 5 ��"' f 0 =s 0 ' '" 0 0 0
- Commercial 3 0 �r 0 \ 12 4 12
- Service 3 �. '� a , a. 0 0 :< 0 0 0
Swimming Pool Filter 1 x " h : 0 . 0 0 0
Washer - Clothes 6 `* . 0 F 6t_ 0 0 0 0
x,
Water Extractor 6 0 F x 0 y� 0 0 0
Water Closet - Toilet 6 _ 0 X_ 0
,�1 0 0 0
Urinal 6 E. ar k OW 0 AXE 0
Previous EDU Count ' , 0 0
Capped EDU Credit ' 4. 0
TOTALS 0 _ 0 0 0 8 21 8 21
Current Fixture Value 21 divided by 16 = 1.3 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 21 divided by 16 = 1.3 over (under) $ 3,250.00
Enter EDU Change Here 34� < 3
Notes:
Name: 6C141(-4,t..41- Date: 7/7/b0
Building Division
Note: The property owner shall retain this record for sewer credit purposes. In the event of a credit, this
document stamped "ORIGINAL" shall serve as a credit voucher and must be submitted to the City of
Tigard Building Division to redeem credit towards future system development charges.