Permit CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2003 -00135
f °+f�I�' � DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 5/5/03
SITE ADDRESS; 06650 SW REDWOOD LN 150 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: SPEC SPACE
USA NO: FIXTURE UNITS: 2
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .1 EDU increase. Previous EDU = 14.6 for a total of 233.6 fixture values. Addition of 2 fixture
values, for a new total of 235.6 fixture values = 14.7 current EDU's.
Owner:
FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WM I
PORTLAND, OR 97224 [ SWUSA] Swr Connect 5/5/03 $230.00
[SWUSA] Swr Connect 5/5/03 $0.00
Phone:
Total $230.00
Contractor:
Phone:,
Reg #:
Required Inspections
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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: AI; . r Permittee Signature,? � �
Call (503) 639 -4175 by 7:00 P.M. for an inspection need- ' th ext business day
r
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Accumulative Sewer Tally
Tenant Spec Space This SWRI 2003 -00135
Address: 6650 SW Redwood Ste. 150 This PLM# 2003 -00163
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 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 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- 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 14.6 233.6 233.6
Capped EDU Credit 0
TOTALS 0 233.6 0 0 • 1 2 1 235.6
Current Fixture Value 235.6 divided by 16 = 14.7 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 233.6 divided by 16 = 14.6 Previous EDU
Change 2 divided by 16 = 0.1 over (under) $ 230.00
Enter EDU Change Here 0.1
HISTORY
Per Jaime: use the current info PLM# EDU# SWR#
from the yellow folder. It is PLM# EUU# SWR#
more current. PLM# EDU# SWR# .
Name: 624/4a/Ltd V2e4dtte.1.0 Date: 9'-30 -O 3
Signature of person that calculated this tally sheet and date perfromed is required