Permit CITY TIGARD SEWER CONNECTION PERMIT
` DEVELOPMENT SERVICES PERMIT #: SWR2003 -00131
.� ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/29/03
SITE ADDRESS; 09426 SW WASHINGTON SQUARE RD K -4 PARCEL: 1S126C0 -01107
SUBDIVISION: WASHINGTON SQUARE ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: NUVO
USA NO: FIXTURE UNITS: 6
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .4 EDU increase.Previous EDU = 117 for a total of 1872 fixture values. Adition of 6 fixture values,
for a new total of 1878 fixture values = 117.4 current EDU's.
Owner:
FEES
PPR WASHINGTON SQUARE LLC Description THE MACERICH COMPANY escription Date Amount
9585 SW WASHINGTON SQ. RD. [SWUSA] Swr Connect 4/29/03 $920.00
PORTLAND, OR 97223 [SWUSA] Swr Connect 4/29/03 $0.00
Phone:
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 \-- ‘? Issued by: cOrjA1(2/Lit_. Cc Permittee Signature: 4::27-74
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally -
Tenant Name: Nuvo This SWRt 2003 -00131
Address: 9426 SW Washington SQ. Rd. This PLM# 2003 -00160
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 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dr 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 3 6 3 6
- 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 117 1872 1872
Capped EDU Credit 0
TOTALS 0 1872 0 0 3 6 3 1878
Current Fixture Value 1878 divided by 16 = 117.4 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 1872 divided by 16 = 117.0 Previous EDU
Change 6 divided by 16 = 0.4 over (under) $ 920.00
Enter EDU Change Here 0.4
HISTORY
117 EDU's per Jaimie PLM# EDU# SWR#
PLM# EDU# SWR#
PLM# EDU# SWR#
Name:, y z .,L Date: 4 7 - i-,79-0 , 3
Signature of person that calculated this tally sheet and date perfromed is require