Permit A - CITY OF TIGARD SEWER CONNECTION PERMIT
` lAi DEVELOPMENT SERVICES PERMIT #: SWR2002 -00258
A � J II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/11/02
SITE ADDRESS; 11945 SW PACIFIC HWY 104 PARCEL: 1S135DD -03301
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: TORTILLERIA SAN GABRIEL
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .8 EDU increase. Previous EDU =35.4 for a total of 566 fixture values. Addition of 11 fixture values,
for a new total of 577 fixture values =36.1 current EDU's.
Owner: FEES
TIGARD PROPERTIES INC
2106 SE OCHOCO ST Type By Date Amount Receipt
MILWAUKIE, OR 97222 PRMT CTR 9/11/02 $1,840.00 27200200000
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 purchase a "Tap and Side Sewer' Perm
Issued by: �� Permittee Signatur
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busi es
Accumulative Sewer Tally
Tenant Name: TortilleQa San Gabriel This SWRA 2002 -00258
Site Address: 11945 SW Pacific HWY. #104 This PLM# 2002 -00363
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 0 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- 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 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 34.8 556.8 556.8
Capped EDU Credit 0
TOTALS 0 556.8 0 0 6 13 6 569.8
Current Fixture Value 569.8 divided by 16 = 35.6 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 556.8 divided by 16 = 34.8 Previous EDU
Change 13 divided by 16 = 0.8 over (under) $ 1,840.00
Enter EDU Change Here 0.8
HISTORY
Notes: 50 EDU# SWR#
PLM# EDU# SWR#
PLM# EDU# SWR#
Name: `�,G 1- Date: � ^ //
Signature of person that calculated this tally sheet and date perfromed is required