Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
� DEVELOPMENT SERVICES PERMIT #: SWR2003 -00388
,.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/24/03
SITE ADDRESS; 06650 SW REDWOOD LN 220 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 - 048 ZONING: I - P
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: CSB SYSTEMS
USA NO: FIXTURE UNITS: 5
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .3 EDU increase. Previous fixture values = 241.6, this work adds 5 fixture values for a new total of
246.6.
Owner:
FEES
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI Description Date Amount
PORTLAND, OR 97224 [SWUSA] Swr Connect 11/24/03 $720.00
[SWUSA] Swr Connect 11/24/03 $0.00
Phone:
Total $720.00
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
Issu d by: Permittee Signature: �// _ _
" Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the t business day
Accumulative Sewer Tally
Tenant N CSB Systems This SWR# 2003 -00388
Site Address: 6650 SW Redwood Ln This PLM# 2003 -00589
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 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) 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 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- 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 15.1 241.6 241.6
• Capped EDU Credit 0
TOTALS 0 241.6 0 0 2 5 2 246.6
Current Fixture Value 246.6 divided by 16 = 15.4 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 241.6 divided by 16 = 15.1 Previous EDU
Change 5 divided by 16 = 0.3 over (under) $ . 720.00
Enter EDU Change Here 0.3
HISTORY
Notes: PLM# EDU# SWR#
Per Sheri, UB, 15.1 DU's PLM# EDU# SWR#
__ PLM# EDU# SWR#
N me: K �; (2 CA-441-41/ 1 Date: ///5 6.5
Signat a of person that calculated this tally sheet and date perfromed is required