Permit C ITY OF T I GA R D SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: =:00119
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS; 09718 SW WASHINGTON SQUARE RD F -5 PARCEL: 1S12600 -00300
SUBDIVISION: WASHINGTON SQUARE ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: NUVO
USA NO: FIXTURE UNITS: 16
CLASS OF WORK: ADD DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1 EDU increase
Owner: FEES
PPR WASHINGTON SQUARE LLC Description Date Amount
BY THE MACERICH COMPANY
9585 SW WASHINGTON SQ. RD. [SWUSA] Swr Connect 4/16/2004 $2,400.00
PORTLAND, OR 97223 [SWUSA] Swr Connect 4/16/2004 $0.00
Phone:
Total $2,400.00
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"
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.
Issued by: L. Permittee Signature: DA/ 4 �,0
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
d • Accumulative Sewer Tally Parcel # 1S12600 -00300 .
Tenant Name; Nu4 This SW R# 2004 -00119
Ste Address: 9718 SW Washington Square Rd This PLM# 2004 -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 1 2 1 2
- 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 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 4 8 4 8
- 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 '; > ' 6 1 6
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 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 6 16 6 16
Current Fixture Value 16 divided by 16 = 1.0 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 16 divided by 16 = 1.0 over (under) $ 2,400.00
Enter EDU Change Here 1
Notes: / ,'
- ignature: !IWinIrA.,_ _/ Date: f�/,/l`
: ing Division
Note The property owner shall retain the ORIGINAL sewer tally record If credits exist, this document will serve as a voucher
which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges
i:\Building\Sewer Tally \SewerTallySheet xls 11/19/03