Permit (138) CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR2003 -00126
A DEVELOPMENT HO BMENg Tigard, ) 63 9 -4171 DATE ISSUED: 5/1/03
a - PARCEL: 2S115BA -00101
SITE ADDRESS; 16200 SW PACIFIC HWY/ C i f a,
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: 001 • JURISDICTION: TIG
TENANT NAME: TIGARD TOWN SQUARE
USA NO: FIXTURE UNITS: 27
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 1.7 EDU increase. Previous fixture units were 502.4, this permit added 27 units for a new total of
529.4 fixture units, or 33.1 EDU.
Owner: FEES
BIT HOLDINGS LTD PARTNERSHIP
BY FORUM PROPERTIES INC Description Date Amount
FIVE CENTERPOINTE DR STE 290 [SWUSA] Swr Connect 5/1/03 $3,910.00
LAKE OSWEGO, OR 97035 [SWUSA] Swr Connect 5/1/03 $0.00
Phone:
Total $3,910.00
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: S Permittee Signature: ��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bus' ss day
Accumulative Sewer Tally
Tenant Name Tigard Town Square This SWR# 2003 -00126
Site Address: 16200 SW Pacific Hwy. Ste \I '.- This PLM# 2003 -00142
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 1 5 1 5
- 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 2 4 2 4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 2 6 2 6
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 2 12 2 12
Urinal 6 0 0 0 0 0
Previous EDU Count 31.4 502.4 502.4
Capped EDU Credit 0
TOTALS 0 502.4 0 0 7 27 7 529.4
Current Fixture Value 529.4 divided by 16 = 33.1 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 502.4 divided by 16 = 31.4 Previous EDU
Change 27 divided by 16 = 1.7 over (under) $ 3,910.00
Enter EDU Change Here 1.7
HISTORY
Notes: PLM# EDU# SWR#
PLM# EDU# SWR#
PLM# EDU# SWR#
Name: t_ J % �i/ - Date: .S//03
Sir nature of person that calculated this tally sheet and date perfromed is required