Permit •
` CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2002 -00342
Ali DATE ISSUED: 12/26/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 13185 SW PACIFIC HWY B -1 PARCEL: 2S102CB -00302
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C - G
BLOCK: LOT: 033 JURISDICTION: TIG
TENANT NAME: SALVADORS BAKERY
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .4 EDU increase. Previous EDU =5 for a total of 80 fixture values. Addition of 6 fixture values for a
new total of 86 fixture values= 5.4 current EDUs.
Owner:
FEES
ALADDIN MOTOR INNS
BY BENZENISTE, IRVING Description Date Amount
10155 SW CAPITOL HWY [SWUSA] Swr Connect 12/26/02 $920.00
PORTLAND, OR 97219 [SWUSA] Swr Connect 12/26/02 $0.00
Phone:
Total $920.00
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: I ` ,,L Permittee Signature:
//
all (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
l' r, ° a 1• . .'-'-'if-1,;;;) a This SWRf1 , :),('„,5I--', 5
�* ' ? � � 6 .i i j r f n This PLM# 2002'104' ' �
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 4 ' „, 0 ','„A 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 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
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 0f. 0. -�_. 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 - , ; ; 0 0 0
- Service 3 0 f'e ;
: _` 0 `� >. 6 2 6
eg Swimming Pool Filter 1 0 . 0 . _ 0 0 0
Washer - Clothes 6 ,,- 0 v '' 0 0 0 0
Water Extractor 6 0 0 ;� : i -, 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 :' l •, 0 0 0 0
Previous EDU Count $ 80 80
Capped EDU Credit 0
TOTALS 0 80 0 0 2 6 2 86
Current Fixture Value 86 divided by 16 = 5.4 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 80 divided by 16 = 5.0 Previous EDU
Change 6 divided by 16 = 0.4 over (under) $ 920.00
Enter EDU Change Here
HISTORY
EDU count of 5 from Carol. PLM# ` EDU# , - SWR#
r:�c
PLM# f EDU# SWR# , .,
PLM# f ", EDU# I SWR#
Name: it , , . L. ,_411.. _. . L Date: 0 — / q -0,2___ "'� - Signature of person that calculated this tally sheet and date perfromed is required