Permit CITY TI GARD SEWER CONNECTION PERMIT
4 1111Ib lie l '• DEVELOPMENT SERVICES PERMIT #: s 12/02 -00226
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/12/02
SITE ADDRESS; 06640 SW REDWOOD LN 2ND FL PARCEL: 2S112DA -01300
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 001 JURISDICTION: TIG
TENANT NAME: PORTLAND CLINIC SOUTH
USA NO: FIXTURE UNITS: 101
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 6.3 EDU increase. Previous EDU =14.4 for a total of 230.4 fixture values. Addition of 101 fixture
values, for a new total of 331.4 fixture values = 20.7 current EDU's.
Owner:
FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 PRMT CTR 7/12/02 $14,490.00 27200200000
Phone: Total $14,490.00
•
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
Issue by: /;'!!�' � ���i Permittee Signat - • al ,
Call (50 639 • • 5 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Name: Portland Clinic South This SWRII 2002 -00226
Site Address: 6640 SW Redwood, Tigard This PLM# 2002 -00271
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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 1 2 1 2
- 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) I 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 4 8 4 8
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 _ 22 66 22 _ 66
- 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 4 24 4 24
Urinal 6 0 0 0 0 0
Previous EDU Count 14.4 230.4 / 230.4
Capped EDU Credit 0
TOTALS 0 230.4 0 0 32 101 32 331.4
Current Fixture Value 331.4 divided by 16 = 20.7 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 230.4 divided by 16 = 14.4 Previous EDU
Change 101 divided by 16 = 6.3 over (under) $ 14,490.00
Enter EDU Change Here 6.3
HISTORY
Notes:Previous EDU count pro- PLM# 97 -0237 EDU# SWR# 97 -0239
vided by Jaime, water dept. PLM# 97 -0223 EDU# SWR# 97 -0205
PLM# 970033 EDU# SWR# 97 -0030 /
Name: ZSii,(,� ___ _/ I Date: 9- 9' --Pg.. Signature of person that calculated this tally sheet and date perfromed Is required ��//