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Permit
CITY OF TIGARD SEWER CONNECTION PERMIT PERMIT #: SWR2001 -00296 � i � � DEVELOPMENT SERVICES. DATE ISSUED: 12/6/01 13125 SW Hall Blvd., Tigard, OR 9722 (503) 639 -4171 SITE ADDRESS; 12220 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00300 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG TENANT NAME: LAMB'S THRIFTWAY USA NO: FIXTURE UNITS: 193 CLASS OF WORK: ALT DWELLING UNITS: TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: .8 EDU increase. Increase from 183 value count to 193 value count Owner: FEES BPP RETAIL LLC Type By Date Amount Receipt BY BURNHAM PACIFIC PROPERTIES ATTN: JOHN WATERS PRMT CTR 12/6/01 $1,840.00 27200100000 SAN DIEGO, CA 92101 Total $1,840.00 Phone: 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: ,/ 1.4/71,(1 /5;:e , / Permittee Signature,) 411iY l Call (503) 639 -4175 by 7:00 P.M. . for an inspection needed the next business day Accumulative Sewer Tally 0112 'j L_G LAMB'S THRIFTWAY This SO 2001 -00296 • 12220 SW SCHOLLS his PLM# 2001 -00539 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 2 4 2 4 - 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 2 6 2 6 - 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 11.44 183.04 183.04 TOTALS 0 , 183.04 0 0 4 10 4 193.04 Current Fixture Value 193.04 divided by 16 = 12:1 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 183.04 divided by 16 = 11.4 Previous EDU Change 10 divided by 16 = 0.6 over (under) $ 1,840.00 Enter EDU Change Here 0.8 HISTORY Notes: PLM# ?001 -00529 EDU# 11.3 SWR #)01 -00296 PLM# ?001-00295 EDU# 11.3 • SWR# PLM# • EDU# SWR# Name/ ,„ „, Date: // — k•–O/ . Signature of person that calculated this tally sheet and date perfromed is required •