Permit CITY OF TIGARD
SEWER CONNECTION
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DEVELOPMENT SERVICES PERMIT #PERMIT SWR98 -0235
DATE ISSUED: 09/11/98
PARCEL: 1S134BC -00300
SITE ADDRESS...: 122 66 SW SCHOLLS FERRY RD
SUBDIVISION • ZONING: C —G PD
BLOCK LOT • JURISDICTION: TIG
TENANT NAME :DOTTY'S 8B
USA NO • FIXTURE UNITS...: 16
CLASS OF WORK,...: ALT DWELLING UNITS..: 1
TYPE OF USE -COM NO. OF BUILDINGS: 0
INSTALL TYPE :BUSWR IMPERV SURFACE: 0 sf
Remarks: Tenant improvement plumbing additions
Owner: FEES
PORTLAND FIXTURE type amount by date recpt
7180 SW FIR LOOP PRMT $ 2300.00 DEB 09/11/98 98- 309065
SUITE 100
TIGARD OR 97223
Phone #:
Contract or:
OWNER
Phone #: $ 2300.00 TOTAL
Reg #..
REQU IRED 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
952 -001 -0010 through OAR 952- mq-0080. You may obtain copies of
these rules • questions to OUNC by calling (503)246 -1987.
Issue by: Permittee Signatureq�
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
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Accumulative Sewer Tally
nant Name: Da rT y / This SWR# 5W/2q 9 - ,0a 3
dress: / P a(o 5A) Sc ,/otc s F.c,PY O This PLM #: PG/i'l i5� O 3 /7
lure ` Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
ptistry/Font 4
th - Tub /Shower 4 ,
- Jacuzzi/Whirlpool 4
it Wash - Each Stall 6
- Drive Through 16
ispidor/Water Aspirator 1
shwasher - Commercial 4 # _ -
- Domestic 2
•
inking Fountain 1
'e Wash 1 . /
or Drain/sink - 2 inch 2 cP .3 . 6
-3inch 5 .
- 4 inch 6
.- Car Wash Dm , 6 _
arbage Disposal 16
Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48 .
e Machine/Refrigerator Drains 1
it Sep (Gas Station) 6 ,
ec. Vehicle Dump Station 16
hower - Gang (Per Head) 1
• - Stall 2
ink .Bar/Lavatory 2 .
- Bradley 5
- Commercial 3
-. Service 3 ,
swimming Pool Filter .1
Vasher - Clothes 6 —
Vater Extractor 6 ,
Vater Closet - Toilet 6 / 10 I
lrinal 6 . / /
•
C
'OTALS /60d /
t otal fixture v a l u e s : y �/ D ` . / - PQ V) g � (O ' v -
l��v divided by 16 = 1/ EDU
-I(STORY /O DU pe-e4 et- (Q4 >9 `s•`Y
3 LM# EDU# SWR# PLM# EDU# SWR#
'LM# EDU# SWR# PLM# EDU# SWR#
'LM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
Adsts%swrtaly.doc .
CITY OF TIGARD
EXPENDITURE REQUEST
This form is a multi -use form. Appropriate receipts and documentation must be attached to this
form. Approved request due Tuesday 5:00 PM to A/P for checks by Friday (week opposite
payroll only).
VENDOR NO.: DATE: 9 -14 -98
PAYABLE TO : CPC L Sony Inc I:L)i.:LS I 131': L)cbiri:::1:i.ii; ski
12200 SW Fairfield
Beaverton Olt 97005
MISCELLANEOUS :EXPLNDITURES
Date Description,.In�oice No etc Ac nt No Amount
9 -11 -98 Erroneously charged f r sewer
inspection fee - amoult is to be \
refunded
Receipt #98- 309065
Permit #SWR98 -0235 (r• .tty's)
12266 Sw Scholls Ferry R6\
9 -11 -98 Sewer Inspection e 29- 0000 - 441001 $75.00
1
TOTAL $75.00
Mileage 32. , ¢
APPROPRIA • N BALANCE: AS OF: PURCHASING:
APPROVALS:
(IF UNDER $50) Section Manager/Professional Staff
(IF UNDER $2500) Division Manager
(IF UNDER $7500) Department Manager
(IF UNDER $25000) City Administrator
(IF OVER $25000) Local Contract Review Board
•
3/6/00 Activities for Case #: SWR98 -00235 •
12:57:00 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRC008 Permit Created 9/10/98 GEO DONE _ GEO 9/10/98
SWRCO25 USA Sewer Card Processed • 9/10/98 • GEO DONE GEO 9/10/98
SWRC080 (F) Issue permit 9/11/98 DEB DONE DST 9/11/98
SWRC720 Case Fineled 9/16/98 JMH NA J'H 9/16/98 du only
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