Permit CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2002 -00206
- DEVELOPMENT H BMENg S RR9 ACES 6 39 -4171 DATE ISSUED: 6/17/02
SITE ADDRESS; 12930 SW SCHOLLS FERRY RD PARCEL: 1S133AD -02200
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: WESTGATE BAPTIST CHURCH
USA NO: FIXTURE UNITS: 66
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .1EDU increase: Previous fixture count was 64, this permit added 2 fixture values for a new total of
66 fixture values or 4.1 EDU's for an increase of .1 EDU.
Owner:
FEES
WESTGATE BAPTIST CHURCH
12930 SW SCHOLLS FERRY RD Type By Date Amount Receipt
TIGARD, OR 97223 PRMT CTR 6/17/02 .$230.00 27200200000
Phone: Total $230.00
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" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 95 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: �r�-/�,/ aitGt /fi Permittee Signature: / v c'ti
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Name: V aptist Church This SWRh 2002 -00206
Site Address: 12930 SW Scholls Ferry Rd. This PLM# 2002 -00223
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 o
- JacuzziNVhirlpool 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 1 6 0 -1 -6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 4 64 64
Capped EDU Credit 0
TOTALS 0 64 1 6 2 8 1 66
Current Fixture Value 66 divided by 16 = 4.1 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 64 divided by 16 = 4.0 Previous EDU
Change 2 divided by 16 = 0.1 over (under) $ 230.00
Enter EDU Change Here 0.1
HISTORY
Notes: PLM# EDU# SWR#
PLM# EDU# SWR#
PLM# EDU# SWR#
Name: r.t 1-/e-e.Gr y i' /.1./.' Date: 6 -/ O a
Signature of person that calculated this tally sheet and date perfromed Is required