Permit CITY TI GARD SEWER CONNECTION PERMIT
1 DEVELOPMENT SERVICES PERMIT #: SWR2001 -00174
,l-
, ".1 1 - DATE ISSUED: 5/18/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4
SITE ADDRESS; 15115 SW SEQUOIA PKWY 100 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: HEWLETT PACKARD
USA NO: FIXTURE UNITS: 67
CLASS OF WORK: ALT DWELLING UNITS: 4
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 4.1 EDU increase. Installation of (1) sink, (4) lays, (3) water closets, (1) urinal, (1) garbage
disposal, (2) 2" floor drains, (1) water heater, (1) drinking fountain, (1) ice maker & (2) primers.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 PRMT CTR 5/18/01 $7,130.00 27200100000
Total $7,130.00
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 Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You m- o • ain •• • ies of these rules or direct questions to OUNC by calling (503) 24. 987.
Iss ed b y: � _O Permittee Signature: ! •
. 1� i�� i
Call (503)6 -4175 by 7:00 P.M. for an inspection needed the next business day
i`ei'+ant'iVame: /lEtUZ Fn /'�CZ Accumulative Sewer Tally
This SWR#
Address: /5//5 / X'/ — �C/ 7
5// 5 e3w £6, u c �,,r P �lcv y 11/ This PLM #:
� o0 /- oG / /�
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total
# Value Capped added ed off value added # Nei
#s tots
Count off #s count value
Baptistry/Font 4 valuc
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
- 4 inch 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 g
- Bradley 5
- Commercial 3 1 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 3
Urinal 6
e0
TOTALS o � S/ j�
Total fixture values: 2 9
d J n d ivided by 16 = ay. 7y EDU = o 74 , / , •, 7 — 2/- $ (f)et . 7 _ 3. / �4
HISTORY _ .
G ../ *Dc.c S o � .�oo - '7,/30 '
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PLM# EDU# SWR# PLM# EDU# SWR#
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