Permit A • CITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2003 -00367
� DEVELOPMENT H BMENg r S O ERV SERVICES 639 -4171 DATE ISSUED: 11/18/03
SITE ADDRESS;
/D35o Su/ L /NCDL .s1 PARCEL: 1S135AB -00100
SUBDIVISION: TOWN OF METZGER ZONING: R -4.5
BLOCK: LOT: 005 JURISDICTION: TIG
TENANT NAME: METZGER ELEMENTARY SCHOOL
USA NO: FIXTURE UNITS: 650
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 3.6 EDU increase. Demo existing building w/37 EDU's, new building fixures =650 less 592 capped
fixtures =net increase of 58 fixtures or 36 3.6 EDU's.
Owner:
FEES
WASHINGTON CLACKAMAS CO
SCHOOL DIST 23J Description Date Amount
6960 SW SANDBURG STREET [SWUSA] Swr Connect 11/18/03 $8,640.00
TIGARD, OR 97223 [SWUSA] Swr Connect 11/18/03 $0.00
Phone:
Total $8,640.00
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
Issued by: Permittee Si gnature: (,- 240`
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Name: Metzger Elementary. School This SWR# 2003 -00367
Site Address: This PLM# 2003 -00509
/0 336 514/ L /NGO -N $-r
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• 1 4 1 4
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 . 0 3 3 3 3
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 25 125 25 125
- 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 .2 64 2 64
- 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 20 . 40 20 40
- Bradley 5 0 0 • 0 0 0
- Commercial 3 0 0 60. 180 60 180
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 . 0 0• 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 30 180 30 180
Urinal 6 0 0 • 8 48 8 48
Previous EDU Count 37 . 592 592
Capped EDU Credit 37 592
TOTALS 0 _ 592 0 0 150 650 150 _ 650
Current Fixture Value 650 divided by 16 = 40.6 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 592 divided by 16 = 37.0 Previous EDU
Change 58 divided by 16 = 3.6 over (under) $ 8,640.00
Enter EDU Change Here 3.6
HISTORY
Notes: PLM# EDU# SWR#
Demo existing bldg w/37 EDU's PLM# EDU# SWR#
PLM# EDU# SWR#
ame: , , 4,∎ -1.ii.� 11(! _i. :I Date: OA 4 3
_`gnature o person that calculated this tally sheet and date perfromed is required