Permit 3 /i ° �
A:PIITY p OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 -00092
13125 S a= r_ • , Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/19/03
•
SITE ADDRESS; 1-6655
74TH AVE PARCEL: 2S113AB -00800
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: EXCEL ORTHODONICS
USA NO: FIXTURE UNITS: 26
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.6 EDU increase: previous EDU count of 2.0 or 32 fixtures, plus increase of 26 fixtures for a new
total of 58 fixtures, fora new EDU of 3.6.
Owner: FEES
DUNCAN, JOHN A AND
JANICE LEE Description Date Amount
7060 SW PALMER WAY [SWUSA] Swr Connect 3/19/03 $3,680.00
BEAVERTON, OR 97007 [SWUSA] Swr Connect 3/19/03 $0.00
Phone:
Total $3,680.00
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
Issue• .:•+// _r:1,1 �lfyl,�` .A,. Permittee Signature:
CaII (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
, , ,..
ir
A - - CITY OF TIGARD SEWER CONNECTION PERMIT
�I DEVELOPMENT SERVICES PERMIT #: SWR2003 -00092
- t ; I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/19/03
SITE ADDRESS; 16055 SW 74TH AVE PARCEL: 2S113AB -00800
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: 1 -
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: EXCEL ORTHODONICS
USA NO: FIXTURE UNITS: 26
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.6 EDU increase: previous EDU count of 2.0 or 32 fixtures, plus increase of 26 fixtures for a new
total of 58 fixtures, fora new EDU of 3.6.
Owner: FEES
DUNCAN, JOHN A AND
JANICE LEE Description Date Amount
7060 SW PALMER WAY [SWUSA] Swr Connect 3/19/03 $3,680.00
BEAVERTON, OR 97007 [SWUSA] Swr Connect 3/19/03 $0.00
Phone:
Total $3,680.00
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
/ / 7 ,'
Issued by: , 1_ ...,A . , _ Permittee Signature: Ap .,__ (_ ��
eir Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant ivame: Excel Orthodonics This SWRA 2003 -00092
Site Address:' .BSW 74th Ave. / j fj This PLM# 2003 -00084
15
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
-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 1 2 1 2
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 8 24 8 24
- 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 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 2 32 32
Capped EDU Credit 0
TOTALS 0 32 0 0 9 26 9 58
Current Fixture Value 58 divided by 16 = 3.6 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 32 divided by 16 = 2.0 Previous EDU
Change 26 divided by 16 = 1.6 over (under) $ 3,680.00
Enter EDU Change Here 1.6
HISTORY
Notes: Current EDU count PLM# EDU# SWR#
provided by Jamie. PLM# EDU# SWR#
PLM# EDU# SWR#
Name: Date: - V /i /a-3
i gnature of person that ca culated this tally sheet and date perfromed is required