Permit (137) CITY TIGARD SEWER CONNECTION PERMIT
autoo Ai' DEVELOPMENT SERVICES PERMIT #: SWR2002 -00023
°�I II 13125 SW Hall Blvd., Tigard, OR 9 7 223 (503) 639 -4171 DATE ISSUED: 2/1102
SITE ADDRESS; .16200 SW PACIFIC HWY Y PARCEL: 2S115BA -00101
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: 001 JURISDICTION: TIG
TENANT NAME: DOLLAR TREE
USA NO: FIXTURE UNITS: 24
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Rmarks 1.5 EDU increase. Previous fixture values were 478.4, this permit added 8 values, for a new total
-- of 502.4, or a net increase of 24 fixtures values.
Owner: FEES
BIT HOLDINGS LTD PARTNERSHIP
BY FORUM PROPERTIES INC Type By Date Amount Receipt
FIVE CENTERPOINTE DR STE 290 PRMT CTR 2/1/02 $3,450.00 27200200000
LAKE OSWEGO, OR 97035 Total $3,450.00
Phone:
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" Perm
Issued by: Permittee SignaturV /45k
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Name: Dollar Tree This SWR# 2002 -00023
Site - Address: 16200 SW Pacific Hwy Y This PLM# 2002 -00026
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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 2 4 2 4
- 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 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- 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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 29.9 478.4 478.4
Capped EDU Credit 0
TOTALS 0 478.4 0 0 8 24 8 502.4
Current Fixture Value 502.4 divided by 16 = 31.4 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 478.4 divided by 16 = 29.9 Previous EDU
Change 24 divided by 16 = 1.5 over (under) $ 3,450.00
Enter EDU Change Here 1.5
HISTORY
Notes: PLM# 2000 -00292 EDU# 29.9 SWR# 2000 -00233
PAM# 1999 -00372 EDU# 29 SWR# 1999 -00240
PLM 1999 -00237 EDU# 29 SWR# 1999 -00162
ame: i i \ . 2()OP,14l WI r Date: N/ A
Signature of person that calculated this tally sheet and date perfromed Is required