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Permit
flW C 1TY OF TIGARD SEWER CONNECTION PERMIT Alt DEVELOPMENT SERVICES PERMIT #: SWR2002 -00341 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/4/03 SITE ADDRESS; 14800 SW SEQUOIA PKWY PARCEL: 2S112AD -00900 SUBDIVISION: ZONING: I -P BLOCK: LOT: JURISDICTION: TIG TENANT NAME: HOME DEPOT USA NO: FIXTURE UNITS: 7 CLASS OF WORK: ADD DWELLING UNITS: TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: ,4 £bk 1 00-1 UR6E -- • Owner: FEES HOME DEPOT USA INC 370 CORPORATE DRIVE Description Date Amount TUKWILA, WA 98188 [SWUSA] Swr Connect 2/4/03 $920.00 [SWUSA] Swr Connect 2/4/03 $0.00 Phone: 1- 206 -574 -3567 Total $920.00 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 sued by: �` . /;ir' — j4 4, , / Permittee Signature: - Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next bush ess day • Accumulative Sewer Tally Tenant Nwme7 lyome Depot (Tool Rental) This SWR# 2002 -00341 Site Address: 14800 SW Sequoia Pkwy This PLM# 2002 -00484 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 1 1 1 1 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 Drr 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 1 6 1 6 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 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 6 96 96 Capped EDU Credit 0 TOTALS 0 96 0 0 2 7 2 103 Current Fixture Value 103 divided by 16 = 6.4 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 96 divided by 16 = 6.0 Previous EDU Change 7 divided by 16 = 0.4 over (under) $ 920.00 Enter EDU Change Here 0.4 . HISTORY Notes:Per Sheryl /Acct, 6 EDU's PLM# EDU# SWR# PLM# EDU# SWR# • - - - -K l# EDU# W R# t Date: � �" /l0 ( Name: _ _ 1Z I �� _, . Signature of pe on that calculated this ally sheet and date perfrom d is re uired