Permit CITY TIGARD SEWER CONNECTION PERMIT
7 u� DEVELOPMENT SERVICES PERMIT #: SWR2003 00396
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/03
SITE ADDRESS; 11705 SW PACIFIC HWY N PARCEL: 1S136CD -00100
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: DREAM NAILS
USA NO: FIXTURE UNITS: 10
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .6 EDU increase. 2 -2" floor drains and 2 foot spas.
Owner:
FEES
PACIFIC CROSSROADS PROPERTIES, I Description Date Amount
BY WYSE INVESTMENT SERVICES CO
200 SW MARKET ST STE 345 [SWUSA] Swr Connect 12/8/03 $1,440.00
PORTLAND, OR 97201 [SWUSA] Swr Connect 12/8/03 $0.00
Phone:
Total $1,440.00
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 by: ')4,A604_, � Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the nex, business ! ay
Accumulative Sewer Tally Parcel # 1s136CD -00100
Tenant Name: bream Nails This SWRA 2003 -00396
Site Address: 11705 SW Pacific Hwy. This PLM# 2003 -00609
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 2 4 2 4
- 3 inch 5 0 0 0 0 0
- 4 inch 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 0 • 0 0
- Service 3 0 0 2 6 2 6
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 20 320 320 •
Capped EDU Credit 0
TOTALS 0 320 0 0 4 10 4 330
Current Fixture Value 330 divided by 16 = 20.6 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 320 divided by 16 = 20.0 Previous EDU
Change 10 divided by 16 = 0.6 over (under) $ 1,440.00
Enter EDU Change Here 0.6
Notes:
Name: C hi. i .�} /EGs° ..f'i e.r7 Date: ,/. -6 5
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.