Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
il vtVer� DEVELOPMENT SERVICES PERMIT #: SWR2002 -00192
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/11/02
SITE ADDRESS; 15862 SW 72ND AVE 150 PARCEL: 2S112DD -00200
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: VERIFONE
USA NO: FIXTURE UNITS: 18
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .2 EDU increase. Previous fixture values were 197, with a .9 EDU credit. This permit added 18
fixture values, after deducting the credit amount there was still a .2 EDU increase.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 PRMT CTR 6/11/02 $460.00 27200200000
Total $460.00
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
Issu by: adttieCat---W-' P ermittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the • xt business day
Accumulative Sewer Tally
Tenant Name: Verifcae This SWR# 2002 -00192
Site Address: '15862 SW 72nd Ave This PLM# 2002 -00208
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 2 4 2 4
- 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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 12.1 193.6 193.6
Capped EDU Credit 0.9 14.4
TOTALS 0 , 193.6 0 0 5 18 5 197.2
Current Fixture Value 197.2 divided by 16 = 12.3 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 193.6 divided by 16 = 12.1 Previous EDU
Change 3.6 divided by 16 = 0.2 over (under) $ 460.00
Enter EDU Change Here 0.2
HISTORY
Notes: PLM# 2002 -00031 EDU# 12.1 SWR# N/A
PLM# 2001 -00436 EDU# 13 SWR# N/A
- RUM 2001 -00078 EDU# 12.8 SWR# N/A
me: i\,_ _ 4 7ru v l c Date: l0 /// i
-SIgnature of person that caulated this tally sheet and date pen` med is required