Permit ,
,,l ` - CITY OF TIGARD SEWER CONNECTION PERMIT
I DEVELOPMENT SERVICES PERMIT #: SWR2002 - 00110
1 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/25/02
SITE ADDRESS; 11705 SW PACIFIC HWY M PARCEL: 1S136CD 00100
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: QUIZNO'S
USA NO: FIXTURE UNITS: 13
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .8 EDU increase.Previous fixture count was 320. this permit added 10 fixture values for a new total
of 333 fixture values or 20.8 EDU's for an increase of .8 EDU.
Owner:
FEES
PACIFIC CROSSROADS PROPERTIES, Type By Date Amount Receipt
BY WYSE INVESTMENT SERVICES CO
200 SW MARKET ST STE 345 PRMT CTR 2/25/02 $1,840.00 27200200000
PORTLAND, OR 97201 Total $1,840.00
Phone:
•
Contractor:
Phone:
Reg #:
. Required Inspections
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 purcha-- a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to folio ules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 throuA p 6 ` R 1.2- 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -19.87 n
r'
Issued by: a,r�r` � Permittee Signature
// � %:!
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally -),,3-
Tenant Name:Quizno's This SWR/4 2002 -00110 . ._. _
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Site Address:11750 SW Pacific Hwy. This PLM# 2002 -00064
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 3 6 3 6
- 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 2 4 3 6 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 . 0 2 6 2 6
- Service 3 0 0 - 1 3 1 3
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 1 6 2 12 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 20 320 320
Capped EDU Credit 0:625 10
TOTALS 0 320 3 10 11 33 8 333
Current Fixture Value 333 divided by 16 = 20.8 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 320 divided by 16 = 20.0 Previous EDU
Change 13 divided by 16 = 0.8 over (under) $ 1,840.00
Enter EDU Change Here 0.4
HISTORY
Notes: PLM# 1999 -00197 EDU# 20 SWR# 1999 - 001,41
PLM# 98 -00369 EDU# 20 SWR# 98 -0369
PLM# EDU# SWR#
Name: A _i, / ,.A..r %. ^ Date: - a- `3 — C 7 ,, , --
• Signature of person that calculated this tally sheet and date perfromed is required