Permit - CITY OF TIGARD
„,,t ,,s„ DEVELOPMENT SERVICES SEWER CONNECTION
13125 SW HaII Blvd., Tigard, OR 97223 (503) 639.4171
PERMIT
PERMIT # • SWR97 -0423
DATE ISSUED: 12/05/97
PARCEL: 2S1O2CB- 00303
SITE ADDRESS...: 13165 SW PACIFIC HWY
SUBDIVISION -NORTH TIGARDVILLE ADDITION ZONING: C —G
BLOCK LOT :033 JURISDICTION: TIG
TENANT NAME -BURGER KING
USA NO • FIXTURE UNITS...: 2
CLASS OF WORK...:ALT DWELLING UNITS..: —2
TYPE OF USE •COM NO. OF BUILDINGS 1
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
Remarks: Plumbing TI. Sewer tally assessed by Mike S. and Tris - .vided curren
t
EDU billing at 5 DU's
Owner: FEES
BURGER KING type amount by date recpt
PRMT $ 0.00 JDA 12/05/97 —
Phone #:
Contractor:
OWNER
Phone #: $ 0.00 TOTAL
Reg #..
REQUIRED INSPECTIONS
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
95241 -00l@ through OAR 952- 0031 -80. You may obtain copies of
these rules or direct questions to OUNC by calling (503)246 -1987.
Issued by: t, �/i /,L.� Permittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Tenant Name: hUr Ld ( Accumulative Sewer Tally This SWR#: 5 W$- 7 - Cid 9 3
Address:. This PLM#: PI,M 'r7
•
.
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
1 •
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
' t 1
- Domest 2
Drinking Fountain 1 I • •
Eve Wash 1
Floor Drain /sink - 2 inch 2 r ins (y I Ant< a I ,
- 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 a I d.)
•
Sink - Bar /Lavatory 2 5 (.9 3 io
r
- Bradley 5
- Commercial 3 • • r
- Service 3
•
Swimming Pool Filter 1
•
Washer, Clothes 6
•
Water Extractor 6
1
Water Closet, Toilet 6 , ,2.,/ j �, A. IX
Urinal • 6
TOTALS � ' 4 .�
Total fixture v Lit divided by 16 = 2.67 EDU -I- le = L}S _ f a .g
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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•
CITY OF TIGARD BUILDING INSPECTION DIVISION &)1
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: /-Z – C 5 - 9 7 A.M. P.M. MST: .
1
Location: .316 5 . ) , _ AIWA BUP:
Tenant: Suite: Bldg: MEC:
Contractor. / if: .C,_ / eze.et 1 . . 4 Phone: 6 (- 4:1- PLM: cz/ 7-4 )/
Owner. Phone: ELC:
e t.).
. •!.l (2 e A,/iZL -' G(� "LI / FIR:
SIT:
BU L BLDG (con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site Post/Beam P Post/Beam Cover /Service Sewer /Storm
Footing Roof (UndFl/Slab ; Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bunt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved A Approved Approved Approved
Appr /Sdwlk Not Approved Not Approved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
•
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AVM
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Cl Aiv ' ......7 4----7------- 77 . .F. , -, 74 ' .__•__. -aro
•
Call for reinspection Cl Reinspection fee of $ required before next • ion . Cl Unable to inspect
Inspector. l Date: / 2/ 0 3 Page_ of / /