Permit _ .� ..w. e
SEWER CONriECTION
PERMIT •
.CITY O F T I GARD DATE PERMIT
05/03/96 -0047
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 2 S 101 AA - 09001
SITE ADDRESS...: 12585 SW 68TH AVE
SUBDIVISION • WEST PORTLAND HEIGHTS ZONING: C —P .
BLOCK • LOT •29
TENANT NAME °ROTH OFFICE BUILDING
USA NO • FIXTURE UNITS...: 20
CLASS OF WORT'....: NEW DWELLING UNITS..: 1
TYPE OF USE •COM NO OF BUILDINGS: 0
INSTALL TYPE •LTPSWR IMPERV SURFACE: 0 sf
Remarks: RE: PLM96 -0027
Owner: FEES
J T ROTH CONST INC type amount by date recpt
12540 SW 68TH PARKWAY, SUITE B PRMT $ 2200.00 JSD 05/03/96 96- 278962
INSP $ 45.00 JSD 05/03/96 96- 278962
TIGARD OR 97223
Phone *: 639 -2639
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2245.00 TOTAL
Reg #.. :
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect i o n
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' Permit and the Agency wi ins a lateral.
Permittee ermittee Signature: ` :� �.
A _ ....i Issued By. ! -
Call for inspection — 639 -4175
Tenant Name: / ( Accumulates wer Tally This SWR #: c-- IC''' -657)` --"
Address: )25 Sai I Ave , — mu) 10.41 This PLM #: V 4-011) V 7"
.../
Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry /Font 4
Bath - Tub /Shower 4
- Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1 ,
Dishwasher - Commer 4
- Domest 2 / /
Drinking Fountain 1 / /
Eye Wash 1
Floor Drain /sink - 2 inch 2 ,
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink Bar /Lavatory 2 .
- Bradley 5
- Commercial 3 / - 3 / 3
- Service 3 .
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6
Water Closet, Toilet 6 4g / e ' /
Urinal 6
TOTALS - l7 2a
Total fixture values: (�C divided by 16 = (r es - 1 EDU t - c-b`4 c-l- c.
HISTO ,
PL # N\ EDU# SWR# PLM# EDU# SWR#
PL _ / EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
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