Permit (26) A. CITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2003 -00284
rr DEVELOPMENT SERVICES DATE ISSUED: 8/11/03
13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171
SITE ADDRESS; 16200 SW PACIFIC HWY A PARCEL: 2S115AB-01900
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: TIN TIN CHINESE BUFFET
USA NO: FIXTURE UNITS: 128
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 8.0 EDU increase. Previous EDU =33.1 for a total of 529.6 fixture values. Addition of 128 fixture
values, for a new total of 657.6 fixture values =41.1 current EDU's.
Owner:
FEES
BIT HOLDINGS LTD PARTNERSHIP
BY FORUM PROPERTIES INC Description Date Amount
FIVE CENTERPOINTE DR STE 290 [SWUSA] Swr Connect 8/11/03 $19,200.00
LAKE OSWEGO, OR 97035 [SWUSA] Swr Connect 8/11/03 $0.00
Phone:
Total $19,200.00
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 Permittee Signature: r/ ��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the I - busine day
Accumulative Sewer Tally
Tenant Name: Tin Tin Buffet This SWRt 2003 -00284
Site Address: 16200 SW Pacific Hwy. Ste. A This PLM# 2003 -00333
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 12 60 12 60
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 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 1 1 1 1
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 5 10 5 10
- Bradley 5 0 0 0 0 0
- Commercial 3 _ 0 0 2 6 2 6
- 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 6 36 6 36
Urinal 6 _ 0 0 2 12 2 12
Previous EDU Count 33.1 529.6 529.6
Capped EDU Credit 0
TOTALS 0 529.6 0 0 29 128 29 657.6
Current Fixture Value 657.6 divided by 16 = 41.1 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 529.6 divided by 16 = 33.1 Previous EDU
Change 128 divided by 16 = 8.0 over (under) $ 19,200.00
Enter EDU Change Here 8
HISTORY
Previous: from yellow file. PLM# EDU# SWR#
PLM# EDU# SWR#
PLM# EDU# SWR#
Name: /L_, v ��,i Date: 7-5 / -03
Signature of person that calculated this tally sheet and date perfromed is required