Permit CITY TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2003 - 00397
I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/10/04
SITE ADDRESS; 07555 SW HERMOSO WAY PARCEL: 2S101AB 01501
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 021 JURISDICTION: TIG
TENANT NAME: MINUTEMAN PRESS
USA NO: FIXTURE UNITS: 40
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 2.5 EDU's for new office building. Previous residence (demo'd) was on septic, no credits.
Owner:
FEES
LIONEL LLC
BOB DAVIDSON Description Date Amount .
14285 SW PACIFIC HWY [SWUSA] Swr Connect 2/10/04 $6,000.00
TIGARD, OR 97224 [SWUSA] Swr Connect 2/10/04 $0.00
Phone:
Total $6,000.00
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
Issu by: acc„ i Permittee Signature: s . r
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally Parcel # 2S101AB -01501
enant Name: Minuteman Press This SWRA 2003 - 00397'
;ite Address: 7545 SW Hermoso Way This PLM# 2003 -00614
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
laptisery/Font 4 0 0 0 0 0
lath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
;ar Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
)uspidor/Water Aspirator 1 0 0 0 0 0
)ishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 1 2 1 2
)rinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
'loor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 , 0 0 0
3arbage 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
ce Machine /Refrigerator Drain 1 0 0 0 0 0
Dil 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 7 14 7 14
- 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 4 24 4 24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 12 40 12 40
Current Fixture Value 40 divided by 16 = 2.5 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 40 divided by 16 = 2.5 over (under) $ 6,000.00
Enter EDU Change Here 2.5
Notes: Demo'd structure was-
on septic, no credij's< `,\ 7;
Si nature: K v )C-614,y-y.A/G1-4" Date: / — D, � Bug Division
Note: The property o er_shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i:\ Building \Sewer Tally \SewerTallySheet.xls 11/19/03