Permit .1
, A
CITY OF TIGARD
SEWER CONNECTION PERMIT
,Fri DEVELOPMENT SERVICES PERMIT #: SWR2001 -00073
r � I I I 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 3/13/01
SITE ADDRESS; 15055 SW SEQUOIA PKWY 170 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: OREGON LABS
USA NO: FIXTURE UNITS: 6
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Installation of two additional sinks, previous EDU count was 17.87, new count is 18.25, for an
increase of .38 EDU's.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 PRMT CTR 3/13/01 $874.00 27200100000
Total $874.00
Phone:
Contractor:
Phone:
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 Ore ' Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -001 -0080.
You ma obt c opie of these rules or direct questions to OUNC by calling (503) 246 -1987.
• Issue by: � � . �_ (50 �' � �� , Permittee Signature: � 0 /
Call 3) 75 by 7 P.M. for an inspection needed the next business day
� Accumulative Sewer Tally
Tenant me: .- o tJ LA-I65 • This SWR# Q.c /- CM 7 3
Ad ?i ess: / 505S F (7Q This PLM#: Pt-t goo I -- Uo0 7,
•
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value value
Baptistry/Font 4
Bath - Tub %Shower 4
- JacuuilWhirlpool 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
- 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
- Bradley 5
- Commercial 3
- Service 3 6'
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water. Closet - Toilet 6
Urinal 6
TOTALS go � - ( 99;`
Total fixture values: 09-9 divided by 16 = D < s � EDU a....- c#' . ∎ ∎ g Z
C 11 �.
HISTORY • 3$ x a, _ I: 8 71/ ' a Sic
PLM# /999 -00/Gc EDU# /7,.g7 SWR# / -ccv /5 PLM# , .. •
PLM# EDU# SWR# PLM# EDU# SWR#,
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# - • EDU# SWR# PLM# EDU# SWR#
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