Permit 4110, CITY OF TIGARD SEWER CONNECTION PERMIT
Awitig DEVELOPMENT SERVICES PERMIT #: SWR2002 -00096
A I - - ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/2/02
SITE ADDRESS; 17005 SW 92ND AVENUE PARCEL: 2S114A0 -01500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 12
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: .8 EDU's for new Maintenance Building - Phase II of Cook Park Master Plan expansion.
Owner:
FEES
TIGARD, CITY OF
13125 SW HALL Type By Date Amount Receipt
TIGARD, OR 97223 PRMT DEB 5/2/02 $1,840.00 JE #
Total $1,840.00
Phone:
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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
lj
Issued • : / % a/ / Permittee Signature: . �.. i 4._ <eQ/-
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD
SEWER CONNECTION PERMIT
10\ DEVELOPMENT SERVICES PERMIT #: SWR2002 -00096
`` -•� �! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/2/02
SITE ADDRESS; 17005 SW 92ND AVENUE PARCEL: 2S114A0 -01500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 12
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 1.1 EDU's for new Maintenance Building - Phase II of Cook Park Master Plan expansion.
Owner: FEES
TIGARD, CITY OF Type By Date Amount Receipt
13125 SW HALL
TIGARD, OR 97223 PRMT DEB 5/2/02 $1,840.00 JE #
Total $1,840.00
Phone:
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee
the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect
3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer" Perm
Iss ed by: i _44 . '_�� - -. i � •; 1 Permittee Signature: a-A
Call (503) • ' -4175 by 7:00 P.M. for an inspection needed the next business day
s
•
Accumulative Sewer Tally
` TenentN 't4C$do11?ar�Mau ten6ncBO,ildibb = , This SWR 260290096
Site 4ddress 005 W/92 Ave, , „` r , ,, . This PLM# 2002"00 8 ' „ , ` f
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 N 0 , H 0 0 0 0
Bath - Tub /Shower 4 0_;," 0 0 0 0
- Jacuzzi/Whirlpool 4 Fitigill 0 0 krt 0 0 0
Car Wash - Each Stall 6 iiiiiiiii 0 i i f t7 0 0 0 0
- Drive through 16 * ,' 0 t £ . . 0 0 0 0
Cuspidor/Water Aspirator 1 0 wh 0 -,„ 0 0 0
Dishwasher - Commercial 4 j 0 i 0 , 0 0 0
- Domestic 2 F 41 0 0 0 0 0
Drinking Fountain 1 POffi 0 a s y 0 ` :;"` ,,: ` 0 0 0
Eye Wash 1 0 0 ,,ti 0 0 0
Floor Drain /Sink - 2 inch 2 °, ; 0 0 2 ;: 4 2 4
- 3 inch 5 1Wx 0 0 31 0 0 0
- 4 inch 6 0 _ 0 . 0 0 0
- Car Wash Dr 6 0 x 0 ,SII1 0 0 0
Garbage Disposal _
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 r 0 0 0 0
Industrial (over 5 HP) 48 "Y " e
- Ice Machine /Refrigerator Drain 1 "420. . ,. 0 0 0 0 0
Oil Sep (Gas Station) 6 y 0 0 0 0 0
Rec. Vehicle Dump station 16 a ,< il, 0 0 i , 0 0 0
Shower - Gang (per head) 1 k s p2 , 0 , ''S::: 0 0 0 0
y
-Stall 2 ;,� _ 0 v 0 0 0 0
Sink - Bar/Lavatory 2 g! f
- Bradley 5 Z � 0 .. ;y , 0 ,R 0 0 0
- Commercial 3 'r 0. m 0 �_. 0 0 0
3 0 „ 0 '_ ,, 0 0 0
Swimming Pool Filter 1 4 1 = 0 : ; ,," 0 i',, 0 0 0
Washer Clothes = , i 0 i 0 0 0 0
Water Extractor 6 lif (i 0 F' 0 z 0 0 0
Water Closet - Toilet 6 ;$ 0 �.`.; , 0 1 k ,. 6 1 6
Urinal 6 �°
Previous EDU Count `� _: K 0 0
Capped EDU Credit ' ' - a • 0
TOTALS 0 0 0 0 4 12 4 12
Current Fixture Value 12 divided by 16 = 0.8 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 12 divided by 16 = 0.8 over (under) $ 1,840.00
Enter EDU Change Here 0 8
HISTORY r & yy " y730�o/
Notes: New PLM #Ogt`� �Kr ., = ED # SWR# 7°. ',�t - tiT°
PLM# : EDU# SWR# ` 44 `
PLM # fi
�� A EDU# . . S3 SWR # . , m z. _.. a,