Permit [ _ _/
SEWER CONNECTION /
PERMIT
OF TIGARD PERMIT # ^ SWR96—G126
...,,CITY DATE ISSUED: 05/13/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223°o199 (503 639-4171 �
PARCEL: 2S101BC-02800 .
SITE ADDRESS...: 08250 SW HUNZIKER RD
SUBDIVISION....: ZONING: I—L
BLOCK..........: LOT.............:
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TENANT NAME -SEVERSON
USA NO...... .... 1 • FIXTURE UNITS...: 16
CLASS OF WORK...:NEW DWELLING UNITS..: 1
TYPE OF USE ^COM NO. OF BUILDINGS: 0
INSTALL TYPE....:LTPSWR IMPERV SURFACE: 0 sf
Remarks: Construction of i 12,600 sq. ft. pre—engineered steel warehouse
Owner: FEES —
JIM SEVERSON type amount by date recpt
29404 SW HEATER ROAD PRMT $ 2200.00 B 05/13/96 96-279330
INSP $ 45.00 B 05/13/96 96-279330
SHERWOOD OR 97140
Phone #: 684-0443
Contractor: — —
CONTRACTOR NOT ON FILE
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_ ___ _________
Phohe #: $ 2245:00 TOTAL
Reg #..:
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires 180 days from _
the date issuod. The total amount paid will be forfeited ittho _ ___
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 Agenc will install a lateral. _ _____
_
Permittee Si nature: ______ __
• Issued By: »�-� __ _.
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Call for inspection — 639-4175
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Tenant Name: 1 VC. 1 4 7OV`-. HCCUmulaIIVe 5 wer 1 any Ints awtte: • —
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Address: 972- S SW ti t h.wJ lt}Qa(e_ e1J3/' a This PLM #: q6 - AY
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. ture 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
1
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 .
- 3 inch 5
-4inch 6 S
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32 --.'
\ 1
- Ind (over 5 HP) 48 ,
Ice Machine /Refrigerator Drains 1 �-1
Oil Sep (Gas Station) 6 2�
Recreational Vehicle Dump Station 16 '--- )
Shower - Gang (Per Head) 1
`
- Stall 2 , , 4
Sink - Bar /Lavatory . 2 Z "I - q `r
- Bradley 5
Commercial 3
- Service 3 s _ 1
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6
Water Closet, Toilet 6 2— l 2- I 2- 1 2 1
Ur inal r 6 -
TOTALS I l0
Total fixture values: \) 0 divided by 16 = 1 EDU
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
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Page No. 1 CASE HISTORY FOR CASE NO.: SWR96 -0126
JIM SEVERSON
08250 SW HUNZIKER RD
02/11/99
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
SWRA007 Application received / / / / / / 04/02/96 BON
SWRA010 Plan check by / / / / 03/25/96 04/02/96 BON
SWRA020 Check for prcl. restrict. 04/02/96 / / / / 04/02/96 BON
SWRA070 Ready to issue / / / / 05/09/96 PASS B 05/09/96 BON
SWRA080 (F) Issue permit / / / / 05/13/96 PASS B 05/13/96 BON
SWRA705 Sewer Inspection / / / / 07/01/96 PASS TLP 07/02/96 TLP
5WRA720 Case Finaled / / / / 11/15/96 11/15/96 JT