Permit 4
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A CITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2001 -00297
- .I' DEVE HO BMEN9 r SO ER 9 2 (+ES ) 639 -4171 DATE ISSUED: 11/9/01
SITE ADDRESS; 08060 SW PFAFFLE ST PARCEL: 1S136CD -00600
SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: CAMERON PLAZA
USA NO: FIXTURE UNITS: 83
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
•
Remarks: 5.2 EDU increase. Increase from 0 to 83 value count.
Owner: FEES
EEI SOLUTIONS Type By Date Amount Receipt
5665 SW MEADOWS RD, SUITE 300
LAKE OSWEGO, OR 97035 PRMT CTR 11/9/01 $11,960.00 27200100000
Phone: 503 - 294 -2150 Total $11,960.00
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: �j� _d Permittee Signature: �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t iiext business day
Accumulative Sewer Tally
CAF ERON PLAZA This SWRA 2001 -00297
8060 SW PFAFFLE This PLM# 2001 -00540
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 2 2 2 2
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 4 8 4 8
- 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 8 16 8 16
. - Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- Service 3 0 0 2 6. 2 6
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 6 36 6 36
Urinal 6 0 0 2 12 • 2 12
Previous EDU Count 0 0 0
TOTALS 0 0 0 0 25 83 25 83
Current Fixture Value 83 divided by 16 = . 5.2 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
' Change 83 divided by 16 = 5.2 over (under) $ 11,960.00
Enter EDU Change Here 5.2
HISTORY
Notes: PLM# EDU# SWR#
PLM# EDU# SWR#
PLM# EDU# SWR#
Name: _ / . <<a� %.." .w.i._ Date: / / —O' d/
Signature of person that calculated this tally sheet and date perfromed is required