Permit CIT TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR1999 00254
- ' II I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -417 DATE ISSUED: 12/02/1999
SITE ADDRESS; 09495 SW LOCUST ST A PARCEL: 1S126DC-04800
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -
BLOCK: - LOT: 004 JURISDICTION: TIG
TENANT NAME: DERMATOLGY ASSOC.
USA NO: FIXTURE UNITS:
CLASS OF WORK: DEM DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Dummy permit.Capped off value count of 18. Credit 1 EDU.
Owner:
FEES
MBM & ASSOCIATES
9495 SW LOCUST STREET Type By Date Amount Receipt
SUITE A
TIGARD, OR 97223 Total
Phone:
Contractor:
MARXMEN PLUMBING INC
9665 SW 163RD AVE
BEAVERTON, OR 97007
Phone: 579 -2200
Reg #: LIC 00102432
PLM 34-161PB
Required Inspections
ORIGINAL
. .
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' Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copie these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: X. Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Tenant Name: 11%t. (m a -o i\ny M , Accumulative Sewer Tally This SWR #: , S LA- 1 ov15y
Address: .1
, 0 5 5J L o c- f A This PLM #: PLM / 9 fg'-0a `f 46
Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New
Value Capped off value added # added total Its total
Count off ifs count value • values
r
Baptistry/Font 4
Bath - Tub /Shower 4 S r
- 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 I
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 • -
Service 3
Swimming Pool Filter 1 -
Washer, Clothes 6 .
Water Extractor 6
Water Closet, Toilet 6 I
•
•
Urinal 6
TOTALS 2 38 13 2 2_0
Total fixture values: z-Zo divided by 16 = 13.15 EDU it-) tic t / C i)
HISTORY
PLM# 9 -0.24.2. EDU# 1 5 SWR# y'(o - U v ,7 , 3_, PLM# EDU# SWR#
PLM# 97- 00 y30 EDU# 1 6 SWR# .5ait- 9'1.0039) PLM# EDU# SWR#
PLM# EDU# • SWR# PLM# EDU# ' ' SWR# .
PLM# EDU# SWR# PLM# EDU# SWR#
1/31/00 Activities for Case #: SWR1999 -00254
1:44:10 PM •
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRA720 Case Finaled 12/8/99 JMT DONE No Hold JMT 12/8/99
SWRC003 Application received 12/1/99 KJP RECD No Hold KJP 12/2/99
SWRC008 Permit Created 12/2/99 KJP DONE No Hold KJP 12/2/99
SWRCO32 DST Post - Review Completed 12/2/99 KJP DONE No Hold KJP 12/2/99
SWRC080 (F) Issue permit 12/2/99 KJP DONE No Hold KJP 12/2/99
•
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