Permit CITY OF T SEWERPCONIECTION
��.,� DEVELOPMENT SERVICES PERMIT # E ° SWR97 -0030
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 02/20/97
PARCEL: 2S112DA -01300
SITE ADDRESS. °°: 06640 SW REDWOOD LN
SUBDIVISION • MLP96 -0002 ZONING: I --P
BLOCK • LOT •
TENANT NAME -PROVIDENCE CLINIC
USA NO . FIXTURE UNITS...: 175
CLASS OF WORK. ..:ALT DWELLING UNITS..: 11
TYPE OF USE °COM NO. OF BUILDINGS: 0
INSTALL TYPE •LTPSWR IMPERV SURFACE: 0 sf
Remarks: RE: PLM97 -0033
Owner: FEES
type amount by date recpt
INSP $ 45.00 DRA 02/20/97 97- 290655
PRMT $ 24200.00 DRA 02/20/97 97- 290655
Phone #:
Contractor: --
CONTRACTOR NOT ON FILE
Phone #: $ 24245.00 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 a' r instal .teral.
Permittee nature: / _ ' -„,
Issued By. I' ,4
Call for inspection — 639 -4175
/ Accumulative Sewer Tally
Tenant Name: � ry ,-' - de c,- C1-7-1 •-Z Th "
This SWR# �'r - ? c o '� 9 - 3°
Address: ( -' v s ,_ c - E) G•'' ■ .a 6 This PLM#: 0 1419 ? - oa3 3
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added its total
Count off #s count value values
Baptistry/Font 4 •
Bath - Tub /Shower 4 _
- JacuzziNVhirlpool 4
Car Wash - Each Stall _ 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 ' Z Z , z
Eye Wash 1
Floor Drain /sink - 2 inch 2 / �(f III )..0 i3 (o
- 3 inch 5 "',,77��
- 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 / -11 IJ( ) % /to
- Bradley 5 ,+
- Commercial 3 / ag , (1) z`b $ `
- Service 3 ' Ili ! 3 q
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 / /14111 q% S q
Urinal 6
TOTALS 5, i - 57 175 •
Total fixture values: 175 divided by 16 = )0.9 EDU I I '} c ,
HISTORY
PLM# EDU# Nie i'` 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.: SWR97 -0030
• PACTRUST REALTY
06640 SW REDWOOD LN
05/13/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
SWRA007 Application received / / / / 02/06/97 This should include a $45 inspection fee PASS JSD 02/06/97 JD
for the building as there has yet to be
a line tap inspection for the building.
SWRAO10 Plan check by / / / / 02/06/97 02/06/97 JD
SWRA070 Ready to issue / / / / 02/19/97 PASS B 02/19/97 BON
SWRA080 (F) Issue permit / / / / 02/20/97 PASS DRA 02/20/97 DRA
SWRC720 Case Finaled / / / / 01/09/98 01/09/98 JT
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