Permit •
•
CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2004 -00069
+L � I " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/24/04
SITE ADDRESS; 16655 SW 72ND AVE 500 PARCEL: 2S113AC -00101
SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I - P
BLOCK: LOT: 029 JURISDICTION: TIG
TENANT NAME: ARLENCO DISTRIBUTING INC
USA NO: FIXTURE UNITS: 21
CLASS OF WORK: ADD DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.2 EDU increase
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [SWUSA] Swr Connect 2/24/04 $2,880.00
[SWUSA] Swr Connect 2/24/04 $0.00
Phone:
Total $2,880.00
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
.� ter - --
�/G Permittee Signature: Issued by: �c `�(, /�GGf/ 9
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed e t business day
Accumulative Sewer Tally Parcel # 2S113AC - 00101
renant Name: - Arlenco Distributing This SWR# 2004 -00069
Site Address: 16655 SW 72nd Ave #500 This PLM# 2004 -00080
= ixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
3aptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Dar Wash - Each Stall 6 . 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Duspidor/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
-3inch 5 0 0 0 0 0
- 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 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 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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.13 2.08
TOTALS 0 0 0 0 6 21 6 18.92
Current Fixture Value 18.92 divided by 16 = 1.2 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 18.92 divided by 16 = 1.2 over (under) $ 2,880.00
Enter EDU Change Here 1.2
Notes: Credit of (2) fixturelva ues frofi.PLM2002 -110426
Si nature: �.L �-E 4.•L Date: ,,2/94r
B ding Division
Note: The property o ershall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
tw hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
is \Building \Sewer Tally \SewerTallySheet.xls 11/19/03