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Permit w CITY OF TIGARD SEWER CONNECTION PERMIT PERMIT #: SWR2002 -00247 ���;� DEVELOPMENT SERVICES DATE ISSUED: 8/22/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS; 12930 SW SCHOLLS FERRY RD PARCEL: 1S133AD -02200 SUBDIVISION: ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG TENANT NAME: WESTGATE BAPTIST CHURCH USA NO: FIXTURE UNITS: CLASS OF WORK: ALT DWELLING UNITS: 1 TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: LTPSWR IMPERV SURFACE: Remarks: 1 EDU, for sewer connection only. Fixtures are to be roughed -in but no fixtures to be set at this phase of construction. Owner: FEES WESTGATE BAPTIST CHURCH 12930 SW SCHOLLS FERRY RD Type By Date Amount Receipt TIGARD, OR 97223 PRMT CTR 8/22/02 $2,300.00 27200200000 INSP CTR 8/22/02 $45.00 27200200000 Phone: Total $2,345.00 Contractor: Phone: Reg #: Required Inspections Sewer Inspection 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 Sew- ' ' _ -- it.and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by th- Oregon Utility Nb . fication Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. Yo may obtain copies o hese ru-s or direct questions to OUNC by calling (503) 246 -1987. /9 Iss d by: ' � Permittee Signature: Call (503) 63 • -4175 by 7:00 P.M. for an inspection needed the next business day Accumulative Sewer Tally Tenant Name; Baptist This SWR # 2002 -00247 Site Address: 12930 SW Scholls Ferry Rd This PLM# 2002 -00284 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 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 0 0 0 - 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 0 0 0 Urinal 6 0 0 0 0 0 Previous EDU Count 0 0 Capped EDU Credit 0 TOTALS 0 0 0 0 0 0 0 0 Current Fixture Value 0 divided by 16 = 0.0 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change 0 divided by 16 = 0.0 over (under) $ 2,300.00 Enter EDU Change Here 1 HISTORY Notes: Per Gary L, charge 1 PLM# EDU# SWR# EDU only for sewer connection, _ PLM# EDU# SWR# fixtures are to roughed in o POV4# EDU# SWR# o� a N m e: 1 '1, _•_ . �;! ,;;_ Date: Signature • person that calculated this tally sheet and date pe omed is required 4 ‘ Accumulative Sewer Tally Tenant Name, Westgage Baptist Church Addition /gym This SWRA 2002 -00247 Site Address: 12930 SW Scholls Ferry Rd. This PLM# 2002 -00284 Fixture Value Previous Previous Credits Capped Fixture Fixture New # value capped off value added added total count off #s count # value 1L values Baptisery/Font 4 0 0 1 4, 4 Bath - Tub /Shower 4 0 0 0 !/ 0 - Jacuzzi/Whirlpo 4 0 0 0 r 0 Car Wash - Each Stall I MIN 6 0 0 0 A 11 0 - Drive through Mil 16 0 0 0 AI 10 0 Cuspidor/Water Aspirator w 1 0 0 0 Dishwasher - Commercial 4 0 0 1 4 - Domestic • 2 0 0 0 11 0 Drinking Fountain IlL 0 0 4 4 4 Eye Wash 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 0 12 24 24 - 3 inch 5 0 0 0 11 0 - 4 inch 6 0 0 0 11 0 - Car Wash Drn 6 0 0 11 0 Garbage Disposal - Domestic (to 3/4 HP) 16 0 0 0 It 0 - Commercial (to 5 HP) 32 0 0 11 0 - Industrial (over 5 HP) 48 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 It 0 Oil Sep (Gas Station) 6 0 v 0 0 101 0 Rec. Vehicle Dump station 16 0 0 0 11 0 Shower - Gang (per head) 1 0 0 0 It 0 - Stall 2 0 12 24 24 Sink - Bar /Lavatory 2 0 0 25 50 50 - Bradley 5 0 0 0 11 0 - Commercial 3 0 0 24 72 72 - Service 3 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 Washer - Clothes 6 0 0 1 6 6 Water Extractor 6 0 0 0 101 0 Water Closet - Toilet MIT 0 0 ' 20 120 A01 120 Urinal 6 0 0 6 36 36 Previous EDU Count 4 1 65.6 65.6 Capped EDU Credit 0 TOTALS 0 65.6 0 0 106 3 11 409.6 Current Fixture Valu 409.6 divided by 16 = 25.6 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 65.6 divided by 16 = 4.1 Previous EDU Change 344 divided by 16 = 21.5 per (knde $ 49,450.00 -� Enter EDU Change Here 21.5 O &f Po to l � '� HISTORY at- L vwu , ! SI) -- • • Notes: Tally generated,by MS. PLM# 2002 -00223 EDU# 0.1 ' 2002 -00 II evious EDU count from yellow fi PLM# EDU# SWR# PLM# EDU# SWR# cy Name: / / ' / _ 1 Date: 7r — / S -O a. Signature of person that calculated this tally sheet and date perfromed is required i . ��`` Accumulative Sewer Tally Tenant Namegt -.N - • / This SWR #.)F O - OOH, 47 Address: / -If, • Z le j) This PLM #: r'L-Mdcoa -00 -- €V Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added # added #s total Count off #s cou t value values Baptistry/Font 4 / r Bath - Tub /Shower 4 - Jacuzzi/Whirlpool 4 Car Wash - Each Stall \. 6 - Drive Through 16 Cuspidor/Water Aspirator 1 J Dishwasher - Commercial 4 / - Domestic 2 Drinking Fountain 1 K y \/ Eye Wash 1 Floor Drain /sink - 2 inch 2 le‘. - I09-•- - 3 inch 5 - 4 inch 6 - Car Wash Drn 6 Garbage Disposal 16 / - Domestic (to 3/4 HP) - Commercial (to 5 HP) 32 . - Industrial (over 5 HP) ' 42 Ice Machine /Refrigerator Drains 1 Oil Sep (Gas Station) 6 Rec. Vehicle Dump Station 16 , Shower - Gang (Per Head) 1 , ' - Stall 2 / / Sink - Bar /Lavatory 2 AS - Bradley 5 - Commercial 3 A y - Service Swimming Pool Filter 1 / Washer - Clothes 6 Water Extractor 6 Water Closet - Toilet 6 e Urinal 6 TOTALS Total fixture values: divided by 16 = •EDU HISTORY PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# is \dsts\swrtaly.doc SAO 11 �/,t/tO 4-4,Q ' 4 _ 6 - x '1 0 / cvi 2 4 `Jd-�