Permit CITY TIGARD SEWER CONNECTION PERMIT
i DEVELOPMENT SERVICES PERMIT #: SWR2003 -00342
t�� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/12/03
SITE ADDRESS; 15055 SW SEQUOIA PKWY 140 PARCEL: 2SI12DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: GEOENGINEERS
USA NO: FIXTURE UNITS: 12
CLASS OF WORK: ALT _ DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .8 EDU increase. Previous EDU =17.9 for a total of 286.4 fixture values. Addition of 12 fixture
values, for a new total of 298.4 = 18.7 EDUs.
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [SWUSA] Swr Connect 9/12/03 $1,920.00
[SWUSA] Swr Connect 9/12/03 $0.00
Phone: -
Total $1,920.00
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
Issued by: Y / / - Permittee Signature: D--A/
Ca (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
it Accumulative Sewer Tally
Tentnt Name: GeoEngineers This SWR/a 2003 -00342
Site Address: 15055 SW Sequoia Pkwy. Suite #140 This PLM# 2003 -00471
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 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) 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 1 2 1 2
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- 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 EDU Count 17.9 286.4 286.4
Capped EDU Credit 0
TOTALS 0 286.4 0 0 5 12 5 298.4
Current Fixture Value 298.4 divided by 16 = 18.7 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 286.4 divided by 16 = 17.9 Previous EDU
Change 12 divided by 16 = 0.8 over (under) $ 1,920.00
Enter EDU Change Here 0.8
HISTORY
Previous: PLM# EDU# SWR#
17.9 Current EDU from water. PLM# EDU# SWR#
PLM# EDU# SWR#
Name: : E i . , t! J . _ .17.1 Date: �l' / 8'� j 3
Signature of person that calculated this tally sheet and date pe om d is required