Permit CITY OF TIGARD
4 . SEWER CONNECTION PERMIT
;1� DEVELOPMENT SERVICES PERMIT #: SWR2002 -00229
`� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/30/02
SITE ADDRESS; 11636 SW PACIFIC HY PARCEL: 1S136DB -02500
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SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: STARBUCKS
USA NO: FIXTURE UNITS: 67
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 3.2 EDU increase. Previous EDU =1 for a total of 16 fixture values. Addition of 51 fixture values for
a new total of 67 fixture values = 4.2 current EDUs.
Owner: FEES
STARBUCKS COFFEE COMPANY
2401 UTAH AVE. SOUTH Type By Date Amount Receipt
SEATTLE, WA 98134 PRMT CTR 8/30/02 $7,360.00 27200200000
Phone: 206 - 318 -1575 Total $7,360.00
•
Contractor:
Phone:
Reg #:
Required Inspections
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
\ \
Issued • : , �; j h. / 4 ' Permittee Signat
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n, 'nes • ay
Accumulative Sewer Tally
Tenant Farm:: , Starbucks This SWRA 2002 -00229
Site Address: 11636 SW Pacific Highway This PLM #2002 -00264
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 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 3 15 3 15
- 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) i 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 _ 1 1 1 1
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 4 12 4 12
- 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 1 16 16
Capped EDU Credit . o
TOTALS 0 16 0 0 14 51 14 67
Current Fixture Value . 67 divided by 16 = 4.2 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 16 divided by 16 = 1.0 Previous EDU
Change 51 divided by 16 = 3.2 over (under) $ 7,360.00
Enter EDU Change Here 3.2
HISTORY
Previous count 1 EDU PLM# EDU# SWR#
7- 22 -02 per Amanda. PLM# EDU# SWR#
PLM# EDU# SWR#
Name: A' /__ /,s 4__.__ Date: - 7 — —O„2.__
• Signature of person that calculated this tally sheet and date perfromed is required