Permit CITY TIGARD SEWER CONNECTION PERMIT
4 DEVELOPMENT SERVICES , IERMIT #: SWR2003 -00189
c.. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/17/03
SITE ADDRESS; 06650 SW REDWOOD LN 333 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: CENTURY WEST
USA NO: FIXTURE UNITS: 3
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .2 EDU increase. Previous fixture values were 238.4, this permit added 3 for a new fixture value
total of 241.1.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WM I
PORTLAND, OR 97224 [SWUSA] Swr Connect 6/17/03 $460.00
[SWUSA] Swr Connect 6/17/03 $0.00
Phone:
Total $460.00
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
Iss ed by: / d - / A` i _ Permittee Signature: V14
Call (503) .39-4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Name: Century West This SWR# 2003-00189
Site Address: 6650 SW Redwood Ln #333 This PLM# 2003 -00272
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 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 4 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 1 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 U 0
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- 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 0 0 0
Urinal 6 0 0 0 . 0 0
Previous Count 14.9 238.4 238.4
Capped EDU Credit 0
TOTALS 0 238.4 0 0 1 3 1 241.4
Current Fixture Value 241.4 divided by 16 = 15.1 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 238.4 divided by 16 = 14.9 Previous EDU
Change 3 divided by 16 = 0.2 over (under) $ 460.00
Enter EDU Change Here 0.2
HISTORY
Notes: PLM# 2003 -00263 EDU# 14.9 SWR# 2003 -00188
PLM# 2003 -00163 EDU# 14.7 SWR# 2003 -00135
Mt# 2002 -00091 EDU# 14.6 SWR# 2002 -00125
ame: _i'' -U - CA 3_; Date: /0
ted this tall sheet and date erfrois required
Signature of � erson that calculated tally P