Permit 4 CITY OF TIGARD SEWER CONNECTION PERMIT
11 PERMIT #: SWR2003 -00193
� DEVELOPMENT SERVICES DATE ISSUED: 11/21/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 11365 SW TIGARD ST PARCEL: 1S134DC -00700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: BAPS TEMPLE
USA NO: FIXTURE UNITS: 132
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 8.3 EDU's for new temple
Owner:
FEES
BAPS TEMPLE
PO BOX 41160 Description Date Amount
SAN JOSE, CA 95160 [SWINSP] Swr Inspect 11/21/03 $45.00
[ SWINSP] Swr Inspect 11/21/03 $0.00
Phone: 408 - 453 -6464 [SWUSA] Swr Connect 11/21/03 $19,920.00
[ SWUSA] Swr Connect 11/21/03 ' $0.00
Contractor:
Total $19,965.00
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" 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 952 - 001 -0100.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -6699.
1 Issued by: Aie4 _ _ 1 �� L Permittee Signature: e1 J . .� A 'Y
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day_
Accumulative Sewer Tally
Tenant Name: BAS Temple This SWR# 2003 -00193
Site Address: 11365 SW Tigard St This PLM# 2003 -00040
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 1 4 1 4
- 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 2 2 2 2
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 6 12 6 12
- 3 inch 5 0 0 7 35 7 35
- 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 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 3.• ., 6 3 6
Sink - Bar /Lavatory 2 . 0 . 0 11 22 11 22
- Bradley 5 • 0 -_ . 0 • 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 .• - 1 • 3 1 3
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 7 42 7 42
Urinal 6 0 0 ' 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 0
•
TOTALS 0 0 0 0 • 39 132 39 132
Current Fixture Value 132 divided by 16 = 8.3 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 132 divided by 16 = 8.3 over (under) $ 19,920.00
Enter EDU Change Here 8.3
HISTORY
Notes: New PLM# EDU# SWR#
•` - -PLM# EDU# SWR#
PLM# EDU#
( Name: � � g .-/ ll� .. / Date: ii
Signature of . erson that calculated this tally sheet and date p is required