Permit 4a
CITY TIGARD • SEWER CONNECTION PERMIT
C DEVELOPMENT SERVICES PERMIT #: SWR2002 -00164
`�JI� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/14/02
SITE ADDRESS; 11640 SW PACIFIC HWY PARCEL: 1S136DB-02400
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: GEORGE'S GIANT HAMBURGERS
USA NO: FIXTURE UNITS: 57
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL BUSWR IMPERV SURFACE:
Remarks: 3.1 EDU increase. Previous fixture values were 32, capped 8 fixture values and added 57 for a
new total of 81.
Owner: FEES
CHAMPION, RONALD V AND
ROBERTA E Type By Date Amount Receipt
11642 SW PACIFIC HIGHWAY PRMT CTR 5/14/02 $7,130.00 27200200000
TIGARD, OR 97223 Total $7,130.00
Phone:
Contractor:
Phone:
Reg #:
Required Inspections
•
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180
days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency doe$ 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 • / / ,I/ .! J � Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD
SEWER CONNECTION PERMIT
M r DEVELOPMENT SERVICES PERMIT #: SWR2002 -00164
, I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/14/02
SITE ADDRESS; 11640 SW PACIFIC HY PARCEL: 1S136D6 -02400
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: GEORGE'S GIANT HAMBURGERS
USA NO: FIXTURE UNITS: 55
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 3.4 EDU increase. Previous fixture values were 32, this permit added 55 for a new total of 87.
Owner:
FEES
CHAMPION, RONALD V AND
ROBERTA E Type By Date Amount Receipt
11642 SW PACIFIC HIGHWAY PRMT CTR 5/14/02 $7,130.00 27200200000
TIGARD, OR 97223 Total $7,130.00
Phone:
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" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: "� _ ,�, ,a �_ Permittee Signature:
•
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busine = s = ay
e� Accumulative Sewer Tally
„Tenant:iariTi3 ° George's Giant Hamburgers This SWR# 2002-00164
b Site Address: 11640 SW Pacific Hwy This PLM# 2002 -00155
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 8 16 8 16
- 3 inch 5 0 0 1 5 1 5
- 4 inch • 6 . 0 0 0 0 0
- Car Wash Drr 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 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 1 2 2 4 1 2
- Bradley 5 0 0 • 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 5 15 5 15
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 1 6 2 12 1 6
Urinal 6 0 0 • 0 0 0
Previous EDU Count 2 32 32
Capped EDU Credit 0
TOTALS 0 32 2 8 20 57 18 81
• Current Fixture Value 81 divided by 16 = 5.1 Current EDU .1 EDU = $2,300.00
Previous Fixture Value 32 divided by 16 = 2.0 Previous EDU
Change • 49 divided by 16 = 3.1 over (under) $ 7,130.00
Enter EDU Change Here 3.1 .
HISTORY •
Notes: Per Amanda, 2 DU's PLM# EDU# SWR#
PLM# EDU# • SWR#
PLM# EDU# • SWR#
Name: ! // % //, AtiO Date/472—
Signature of person that calculatedkhis tally sheet and date perfromed is required