Permit ~ ~ CITY OF TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2002 -00295
Jyn DEVELOPMENT SERVICES DATE ISSUED: 11/8/02
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 10100 SW WASHINGTON SQUARE RD A -1 PARCEL: 1S1356A -00102
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
TENANT NAME: RED ROBIN
USA NO: FIXTURE UNITS: 256
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 10.8 EDU increase. 83 fixture units capped under BUP2002- 00407. This permit adds 256 fixture
units, increase to be charges is 173 fixture units or 10.8 EDU's.
Owner:
FEES
PPR SQUARE TOO LLC
BY MACERICH COMPANY Description Date Amount
ATTN: JANET FISHER, ASSET MGMT [SWUSA] Swr Connect 11/8/02 $24,840.00
SANTA MONICA, CA 90407
Phone: Total $24,840.00
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: Permittee Signatu -.
Ca I (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant» and Red Robin This SWR# 2002 -00295
Site Address: 10100 SW Washington Sq Rd This PLM# 2002 -00370
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 1 4 1 4
- 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 9 18 9 18
- 3 inch 5 0 0 19 95 19 95
- 4 inch 6 0 0 3 18 3 18
- 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 1 32 1 32
- 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 7 14 7 14
- Bradley 5 0 0 0 • 0 0
- Commercial 3 0 0 11 33 11 33
- 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 6 36 6 36
Urinal 6 0 0 1 6 1 6
Previous EDU Count 0 0
Capped EDU Credit 5.18 82.88
TOTALS 0 0 0 0 58 256 58 173.12
Current Fixture Value 173.12 divided by 16 = 10.8 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 173.12 divided by 16 = 10.8 over (under) $ 24,840.00
Enter EDU Change Here 10.8
HISTORY
Notes:Demo'd fixture count pro- PLM# EDU# SWR#
vided by Roger Ott, Wa Sq Mgr__ PLM# EDU# SWR#
PbM# EDU# SWR#
N a m e l I Da / / /4
Signet • of person that calculated this tally sheet and date perfromed is required