Permit CITY TIGARD SEWER CONNECTION PERMIT
A DEVELOPMENT SERVICES PERMIT #: SWR2002 -00299
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/29/02
SITE ADDRESS; 11745 SW PACIFIC HY 100 PARCEL: 1S136CD -01000
W
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
TENANT NAME: VACANT SPACE
USA NO: FIXTURE UNITS: 20
CLASS OF WORK: ALT DWELLING UNITS: .
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.3 EDU increase, previous fixture count was 72 units, this permit adds 20 for a new total of 92
units.
Owner:
FEES
SMART & FINAL STORES INC
PO BOX 512377 Description Date Amount
LAS ANGELOS, CA 90051 [SWUSA] Swr Connect 10/29/02 $2,990.00
Phone: 503 323 - 869 - 7591 Total $2,990.00
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 S- - ' - • and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by • - Oregon Utility •tification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100.
Y u may obtain copies • these rules or direct questions to OUNC by calling (503) 246 -6699.
I - ued by: � _� A i jjj 4 Permittee Signature: • —rata"
-
Call (503) 639-4 75 by 7:00 P.M. for an inspection needed th business day
\
Accumulative Sewer Tally
Tenant Name: Vacant Space This SWR# 2002 -00299
Site Address: 11745 SW Pacific Hwy #100 This PLM# 2002 -00417
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 0 0 0
- 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 2 4 2 4
- 3 inch 5 0 0 0 0 0
- 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 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 2 4 2 4
- 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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 4.5 72 72
Capped EDU Credit 0
TOTALS 0 72 0 0 6 20 6 92
Current Fixture Value 92 divided by 16 = 5.8 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 72 divided by 16 = 4.5 Previous EDU
Change 20 divided by 16 = 1.3 over (under) $ 2,990.00
Enter EDU Change Here 1.3
HISTORY
Notes: PLM# 2002 -00392 EDU# 4.5 SWR# 2002 -00283
- # EDU# SWR#
PL • / EDU# SWR#
Name:: - �•erl 1 t l� y Date: t.)4 /O .2*
Signa - of person that calculated this tally sheet and date perfromed Is required