Permit •
411410 CITY OF TIGARD SEWER CONNECTION PERMIT
r� DEVELOPMENT SERVICES
PERMIT #: SWR2002 -00236
'�J I I DATE ISSUED: 8/6/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 09802 SW SHADY LN PARCEL: 1S135BD -01200
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: EQUITY ONE
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: .2 EDU increase, previous fixture units were 32, this permit is adding 3 fixture units for a new total
of 35 fixture units.
Owner: FEES
FORBES, DONALD CAROLYN
BURDICK, DONALD LINDA Type By Date Amount Receipt
434 RIDGEWAY RD PRMT CTR 8/6/02 $460.00 27200200000
LAKE OSWEGO, OR 97034 Total $460.00
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" Perm
I / ./ .e!_; Permittee Signature: \/-
Call (503) :39 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Namoi One This SWR# 2002 -00236
Site Address: 9802 SW Shady Ln This PLM# 2002 -00311
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 Dr 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 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 2 32 32
Capped EDU Credit 0
TOTALS 0 32 0 0 1 3 1 35
Current Fixture Value _ 35 divided by 16 = 2.2 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 32 divided by 16 = 2.0 Previous EDU
Change 3 divided by 16 = 0.2 over (under) $ 460.00
Enter EDU Change Here 0.2
HISTORY
Notes: Per Sheryl, 2 EDU's PLM# EDU# SWR#
PLM# EDU# SWR#
• EDU# SWR#
=, ■
Name: _ �! ' � ' SdLii i :�' Date: 8/4'4 '
.Signature of p = on that calculated this tally sheet and date perfromed is required