Permit i
,, A • CITY OF TIGARD SEWER CONNECTION PERMIT
'r DEVELOPMENT SERVICES PERMIT #: SWR2003 -00374
t�� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/03
SITE ADDRESS; 11945 SW PACIFIC HWY 100 PARCEL: 1S135DD -03301
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C - G
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: BREWED AWAKENING
USA NO: FIXTURE UNITS: 7
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .4 EDU increase. Previous fixture units were 720, this permit adds 7 fixture units for a new fixture
total of 727, or 45.4 EDU's
Owner: _
FEES
BREWED AWAKENINGS
11945 SW PACIFIC HWY. Description Date Amount
TIGARD, OR 97223 [SWUSA] Swr Connect 10/16/03 $960.00
[SWUSA] Swr Connect 10/16/03 $0.00
Phone: 360 - 225 - 6826
Total $960.00
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 .Z/72)iri--
Issued by: , L / , - v�� � �� Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
/Tenant Name: Brewed Awakening This SWRt 2003 -00374
Site 11945 SW Pacific Hwy This PLM# 2003 -00530
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 1 3 1 3
- 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 45 720 720
Capped EDU Credit 0
TOTALS 0 720 0 0 3 7 3 727
Current Fixture Value 727 divided by 16 = 45.4 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 720 divided by 16 = 45.0 Previous EDU
Change 7 divided by 16 = 0.4 over (under) $ 960.00
• Enter EDU Change Here 0.4
HISTORY
Notes: See attached note. PLM# 2003 -00457 EDU# 45 SWR# 2003 -00334
PLM# EDU# SWR#
-P-14# EDU# - SWR#
ame: i _ .:i,�!,,,o, �' 1j` //L ! I Date: /D /d Ul�
i gnature • person that calculated this tally sheet and date perfromed is required