Permit CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2003 -00334
II� DEVELOPMENT H BMEN9 Tigard, ) 639 -4171 DATE ISSUED: 9/3/03
SITE ADDRESS; 11945 SW PACIFIC HY 100 PARCEL: 1S135DD -03301
W
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: BREWED AWAKENING
USA NO: FIXTURE UNITS: 1
CLASS OF WORK: ALT DWELLING UNITS: 0
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .2 EDU increase. Previous EDU =44.8 for a total of 716.8 fixture values. Addition of 3 fixture
values, for a new total of 719.8 fixture values = 45 current EDUs.
Owner: FEES
TIGARD PROPERTIES INC
2106 SE OCHOCO ST Description Date Amount
MILWAUKIE, OR 97222 [SWUSA] Swr Connect 9/3/03 $480.00
[ SWUSA] Swr Connect 9/3/03 $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
Iss • d by: •5i - 1 ° -) Permittee Signature: L, ; _:a /��L!/�
Call (503) 6 : -4175 by 7:00 P.M. for an inspection needed the next business day
• Accumulative Sewer Tally
ena . t hJan+,iE: Brewed Ayvakening This SWR 2003 =00334
iteAddress: 11945 SW Pacific Hwy. #100 This PLM# _2003- 00457
ixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
aptisery/Font 4 0 0 0 0 0
ath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
:ar Wash - Each Stall 6 0 0 0 0 0
' - Drive through 16 : 0 0 0 0 0
:uspidor/Water Aspirator 1 c . 0 4' 0 0 0
lishwasher - Commercial 4 0 b 0 0 0
- Domestic 2 0 0 0 0 0
prinking Fountain 1 .. 0 z 0 0 0 0
ye Wash 1 0 0 0 0 0
loor Drain /Sink - 2 inch 2 0 0 0 0 0
- 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
:e Machine /Refrigerator Drain 1 0 0 0 0 0
iil Sep (Gas Station) 6 , , • 0 0 0 0 0
:ec. Vehicle Dump station 16 : 0 .. ,. 0 0 0 0
flower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
;ink - Bar /Lavatory 2 „ 0 0 _ 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 ; ` :..- .: 3 1 3
- Service 3 0 0 0 0 0
wimming Pool Filter 1 0 0 0 0 0
Dasher - Clothes 6 0 0 0 0 0
Dater Extractor 6 .. .. 0 : . 0 0 0 0
Dater Closet - Toilet 6 0 0 0 0 0
Irinal 6 0 0 0 0 0
Previous EDU Count : . 44.8 716.8 716.8
Capped EDU Credit 0
OTALS 0 716.8 0 0 1 3 1 719.8
Current Fixture Value 719.8 divided by 16 = 45.0 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 716.8 divided by 16 = 44.8 Previous EDU
Change 3 divided by 16 = 0.2 over (under) $ 480.00
Enter EDU Change Here 0.2
HISTORY
'revious: Per note of 10/31/02 PLM# EDU# SWR#
in file created by Debbie A. PLM# EDU# SWR#
PLM# EDU# SWR#
Name: qiiiki , _Jr_ Date: 0 -& -0 ;
Signature of person that calculated this tally sheet and date perfromed is required