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Permit CITY T SEWER CONNECTION PERMIT �r DEVELOPMENT SERVICES PERMIT #: SWR2004 -00247 '� I - ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/8/2004 SITE ADDRESS; 13221 SW 68TH PKWY 460 PARCEL: 2S101 DA -00102 SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE BLOCK: LOT: 002 JURISDICTION: TIG TENANT NAME: AUCTIONPAY USA NO: FIXTURE UNITS: 5 CLASS OF WORK: ADD DWELLING UNITS: TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: .3 EDU increase Owner: FEES ROBINSON, ROY Description Date Amount 2655 SEELY AVE. SAN JOSE, CA 95134 [SWUSA] Swr Connecti( 9/8/2004 $750.00 [SWUSA] Swr Connecti( 9/8/2004 $0.00 Phone: 408- 943 -1234 Total $750.00 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 Oreg. - Iti ity : 'fication Center. Those rules are set forth in OAR 952 -001 -0010 through OAR 952 -001 -0100. You ma obtain copies o hese rules or direct questions to OUNC by calling (503) 246 -6699. O p . I Permittee Si nature:`' Iss ed by: 9 X M1U( ktnli Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day _ . Accumulative Sewer Tally Parcel # Tenant l‘:i',A0offoriPai;. .;,-:.,,::;. '::;:.: ;',. ...:?,. This SWRA2004.'70,0247''',2:: Site'AddresS:1:3221,8W,68tli.BkWy4 -#460 • '' r : .:- ;, ... ,' ' :'-, ,. This PLM#20000411 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 'y ; ea. r■-" 0 0 0 -.., ..; - ;-- . , .,;-, Bath - Tub/Shower 4 -•,:r.:,,' -: : 0 ' -.,,,,,,;: ... 0 -,',`;. :7' ; 0 0 0 -Jacuzzi/Whirlpool 4 ,,--., r , , -.', 0 0 0 0 0 ,.; : ,..., ; Car Wash - Each Stall 6 ' .::',,..i..:::- : 0 0 0 0 - Drive through 16 , , t4; :,. ; ,•-•.. 0 1. 0 •';:, :::,...: ;,-', .„ 0 0 0 Cuspidor/Water Aspirator 1 ,-,z. --. ' ,` - ,., ?.,•;,- y':- „:„---:, --, 0 , -t'.., 0 0 0 0 Dishwasher - Commercial 4 ': :,.',.;.:'..',- ' 0 c; '..-:,'":?,!-, 0 0 0 0 - Domestic 2 ; 1,', '-'.,.'-:',. 0 •-?, : ,:,,: 3 :,, 1 0 0 0 0 , - Drinking Fountain 1 Y- '.-..-.: :=;.,. 0 '';2 0 : - "„ 0 0 0 Eye Wash 1 ; ..,....,, :;-',. ? ; k 0 ;';, i, .,,.;,.:.;,.- 0 .".--,-, ,.. ,,. - -, :::, . : 5 2 1 0 0 0 Floor Drain/Sink - 2 inch 2 5.:''' 0 ',-.t -.: 0 1 ; ,• 2 1 2 - 3 inch 5 '',` .;';.,:', :' 0 ., g:, 0 -:,,,.. :,-,-,:,,,----- 0 0 0 - 4 inch 6 ,:-,, , '-' ' : 0 „ .. i , ‘ , , , ,.-.i. 0 0 0 0 - Car Wash Drn 6 'J -.>. - -,-- 0 ,.,,, .,,,,,, 0 0 0 0 Garbage Disposal - Domestic (to 3/4 HP) 16 : 0 ,:'';'- 0 0 0 0 - Commercial (to 5 HP) 32 40 0 '',* ..:..,.;:!,.. 0 0 0 0 =.•,:-- .,.,,,:•,,,,, - Industrial (over 5 HP) 42 - ii ,) 3 -, k 0 - ;>,tiV,; ; .',4 0 0 0 0 Ice Machine/Refrigerator Drain 1 ;-; ...;,., 0 - ' ,-,,.•,‘• ,..i4-..,; 0 ne :$" i , 0 0 0 . ,n;;`, Oil Sep (Gas Station) 6 ?.','-,,,, 3347 0 ',.,,,,:: 0 - ",`',, - ' .,. ,,:' 0 0 0 - - , ?...--.s. Rec. Vehicle Dump station 16 „.::`•' ','-'."; 0 -::' 0 0 0 Shower - Gang (per head) 1 , ,- . ..,? : 'Y., ' 0 , ..`;'''; ''''',.:, , ,., 0 0 0 0 ,., ..,:• ' '-.. , ■ ..` ; '',.".. - Stall 2 .34.::':. ':i,-.'N,; 0 :': '.'''.,:,..;:,;. 0 ,.-'7,-, !'=:'"';'' 0 0 0 Sink - Bar/Lavatory 2 ,:34 ., s,;,3:*.,,,- 0 ,,'-,,'g-.6 0 „,, , .„ ,,,, k.,,,,,,3.3-., , 3 3:-„,, 0 0 0 — Bradley 5 '3 ..- 3- 0 6::. 0 4*, -u , .,..,,,, 0 0 0 '„:v , ..: , , - Commercial 0 .?•-- .. --. p. 9,.., , - 0 ::' lel '5 : k _ 3 1 3 .,,.., .: ..---...:.q...;- ,,,,-„ - Service 3 .: 0 ;1. ',•:114:'0;,: 0 0 0 0 Swimming Pool Filter 1 ,,..-,,,,,, ,..,,” ,-; 0 iir,:t?".1-4.y.,' 0 „ ... , - , =,/,,- , , . , , 0 0 0 Washer - Clothes 6 - -,`- - i, '' 0 , .-P;,3:-,‘,--1,..,3 0 :,ko--,,,..1 g ,,, : 0 0 0 Water Extractor 6 '''....is:'•,:;:.5 0 >7.,- 0 , ,,i-, ,i:40.05.': 0 0 0 Water Closet - Toilet 6 '' " ','- 0 .'” ' „ , , 0 :1” ' '', YY'',: ...!: '3"'''' '''''.'-'.o 0 0 0 Urinal 6 ',-,?; ' ;'3,F!,1 0 3: 0 , -,,k,.,- , „ 3 „3 - 0 0 0 Previous EDU Count -"? -'; .v. ? 0 0 -.,, . Capped EDU Credit - , , ..,, - ,:i:',4 , :, 0 TOTALS 0 0 0 0 2 5 2 5 Current Fixture Value 5 divided by 16 = 0.3 Current EDU 1 EDU = $ 2,500 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 5 divided by 16 = 0.3 over (under) $ 750.00 Enter EDU Change Here ' - - Notes: Date: Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher [ th At hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. i:\Building\Sewer Tally\SewerTallySheet.xls 7/1/04