Permit SEWER CONNECTION
CITY OF TIGARD PERMIT * PERM IT • SWR96 -0390
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 08/28/96
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 26110DC -00200
SITE ADDRESS...: 15660 SW PACIFIC HWY #4
SUBDIVISION • WILLOW BROOK FARM ZONING: C —G
BLOCK • LOT • 1 1
TENANT NAME •NOAH'S BAGELS
USA NO FIXTURE UNITS...: 25
CLASS OF WORK,... : ALT DWELLING UNITS.. : 2
TYPE OF USE -COM NO. OF BUILDINGS: 0
INSTALL TYPE •LTP IMPERV SURFACE: 0 sf
Remarks: Tenant improvement
Owner: —. FEES
STERLING DEVELOPMENT CORP type amount by date recpt
LA JOLLA COPORATE CENTER PRMT $ 4400.00 CJS 08/28/96 96- 283343
3252 HOLIDAY CT #225
LA JOLLA CA 92037
Phone #: 619 - 546 -8841
Contract or:
OWNER
Phone #: $ 4400.00 TOTAL
Reg #...
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
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.
Permittee Signature: MCOece_
Issued B y: _�Y1 ri t I C �
Call for inspection — 639 -4175
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y Accumulative Sewer Tally /��
Tenant Name: ek This SWR# "l[o -bul b
Address: \ 5 ld cb su) t ( t 1 1 Yt This PLM#: 'To 02-9
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4 1 4 1 q
- Domestic 2
Drinking Fountain 1 1' 6 9 q
Eye Wash 1
Floor Drain/sink - 2 inch 2 1 Z(D Z Li- IS- 30
- 3 inch 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32 _
- Industrial (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2 It 2L1 1 Z 2q
- Bradley 5
- Commercial 3 to 1 t 1 q 17
- Service 3 , 1 5 1 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 11 ('U 2... 12- 13 11
Urinal 6
TOTALS 15D I ?5
Total fixture values: 115 divided by 16 = 10. EDU
HISTORY
PLM# • q(, - 033', EDU# q SWR# '1O -j2 7 PLM# EDU# io,.) SWR#
PLM# on, -00 EDU# 1 SWR# o(1% -017 ( PLM# EDU# ' SWR#
PLM# 0 1l % -hut D EDU# D SWR# ' (y9 3 . PLM# EDU# SWR#
PLM# o1(„ -016v/ EDU # -; SWR# 07� =c, PLM# EDU# SWR#
is dstsyimdlswrtay.doc
Page No. 1 CASE HISTORY FOR CASE NO.: SWR96 -0390
NOAH'S BAGELS •
15660 SW PACIFIC HWY Unit: 4
09/17/97
Action Description Reg/ Schd/ End/ Action Notes Disp.By Update Upd
Code Sent Done Done. Date By
-- -- --- -------- ---
SWRA007 Application received / / / / 07/30/96 RECD JD 08/08/96 BON
SWRA010 Plan check by / / / / 07/30/96 08/08/96 BON
SWRA070 Ready to issue / / / / 08/08/96 PASS B 08/08/96 BON
SWRA080 (F) Issue permit / / / / 08/28/96 PASS CJS 08/28/96 CJS
SWRA085 (F) Reprint Permit / / / / 08/28/96 08/28/96 CJS
SWRA720 Case Pinaled / / / / 09/04/96 PASS JDA 09/04/96 JDA
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