Permit y tl
� CITY OF TIGARD SEWER CONNECTION PERMIT
I A, DEVELOPMENT SERVICES
PERMIT #: SWR2000 -00009
J I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/11/2000
SITE ADDRESS; 12442 SW SCHOLLS FERRY RD 206 PARCEL: 1S134BC-00401
SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: DR DECASTRO
USA NO: FIXTURE UNITS: 18
CLASS OF WORK: ALT DWELLING UNITS: 1
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Sewer permit for plumbing TI
Owner:
FEES
SISTERS OF PROVIDENCE IN OR Type By Date Amount Receipt
BY STEVE FOSTER •
PO BOX 13993 PRMT DST 01/11/200C $2,300.00 00- 321062
PORTLAND, OR 97213 Total $2,300.00
Phone:
Contractor:
FULLMAN SERVICE CO LLC
5221 SW CORBETT
PORTLAND, OR 97201 -3716
Phone: 224 -5221
Reg #: LIC 122310 •
PLM 26 -443PB
Required Inspections
F Ag L
ORIGINAL
This Applicant agrees to comply with all the rulesand 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 copies o these rules or direct questions to OUNC by calling (50- 4-1987.
Issued by: 1 i // Permittee Signatur •
Call (50 639 -4175 by 7:00 P.M. for an inspection needed • next bu ne day
j Accumulative Sewer Tally
Tenant Name: b° ll�lS -" v This S k WR # e-Z�� —OM/
Address: I Z NZ 9-0 rail. *ZOO This PLM #: ''L.MLZDDV —7 OO(O
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
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Drain/sink - 2 inch 2
- 3 inch 5
- flinch 6
- Car Wash Drn 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
•
- Bradley 5 �`
- Commercial 3 1 - Wbve/J� Co (`b 1
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS ` q I I
Total fixture values: • VT6 divided by 16 = �2.7 EDU (_ C-1)0 .S ^ I LACAre 4 f •
HISTORY
PLM# 0 11P -PO EDU# I) SWR# Flo -1 PLM# EDU# SWR#
PLM #ptrE { EDU# I o SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:\dsts■swrtaiy.doc
2/16/00 Activities for Case #: SWR2000 -00009
3:11:32 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRC003 Application received 1/4/00 DRA RECD No Hold BON 1/10/00
SWRC008 Permit Created 1/10/00 BON DONE No Hold BON 1/10/00
SWRCO25 USA Sewer Card Processed 1/10/00 BON DONE No Hold BON 1/10/00
SWRCO32 DST Post - Review Completed 1/10/00 BON DONE No Hold BON 1/10/00
SWRC070 Ready to issue 1/10/00 BON DONE No Hold BON 1/10/00 After permit is issued, be sure
to case final as there are no
sewer inspections. Only have
the sewer permit to charge 1
EDU.
SWRC080 (F) Issue permit 1/11/00 GEO DONE No Hold DST 1/11/00
SWRA720 Case Finaled 1/19/00 JMT DONE No Hold JMT 1/19/00
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