Permit •
I CITY OF TIGARD SEWER CONNECTION PERMIT
, ���;� PERMIT #: SWR2000 -00079
DEVELOPMENT SERVICES DATE ISSUED: 04/19/2000
13125 SW Hall B Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS; 15755 SW SEQUOIA PKWY 100 PARCEL: 2S112DD -01601
W
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION:. TIG
TENANT NAME: OREGON ORTHOTIC SERVICES INC
USA NO: FIXTURE UNITS: 137
CLASS OF WORK: ADD DWELLING UNITS: 1
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Replace one (1) existing sink and add three (3) new sinks for tenant improvements. Current fixture
count is 128 add 9 fixtures = 137 = 8.56 or 9 EDU's. This add one to the current count.
Owner:
FEES
PACIFIC REALTY
15350 SW SEQUOIA PKWY • Type By Date Amount Receipt
SUITE 300 PRMT GEO 04/19/200C . $2,300.00 0001562
TIGARD, OR 97223 Total $2,300.00
Phone:
Contractor:
Phone:
Reg #: ORIGINAL
Required Inspections
5 =�r1�2 O'R0S1 '� ° ��'cJ
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 may obtain co ies o these rul- or direct questions to OUNC by calling (503) 246 -1987. !
PO Issued b / Permittee Signature: oy—/;
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
J Accumulative Sewer Tally
1'7 'c 4 1/4T: % This SWR# Sr iva — 00 6 71
Tenant Name. .�
Address:!.: 7 %``' se-) •S tfuai ,Pta�V AP() This PLM #:,�1 o - Cad /�N
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
-3inch 5
-4inch 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 . .43 - q
- Service 3 , •
Swimming Pool Filter 1
Washer - Clothes 6 •
Water Extractor 6 - —
Water Closet - Toilet 6 •
Urinal 6 • •
TOTALS Q
Total fixture values: f 3 7� � divided by 16 = �.
�' EDU ! 1 D Q 0 /9P-P 1 -74 ev.eiCA
• -- (Dar.
HISTORY • per 19rr 4 /4 - c e
PLM# EDU# 6 • SWR# PLM# EDU# SWR#
PLM# EDU# -,SWR# PLM# EDU# - SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# • EDU# SWR# . PLM# EDU# SWR# •
odsts%swrtay.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: , 639 -4171
BUP
Date Requested SP 10/00 AM . PM BLD
Location I! S / $ 3 Sq (in Suite / Q ��11 MEC
"�
Contact Person ° � Ph 351 - 1600 PLM Zy
Contractor Ph SWR 7. `X7 60 d' I
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation n
Drywall Nailing 5 'i? 2O OO - eta / / / � /
Fire wall O A / y `/ // /a.)71/4 9
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Pos & tse m
Under Slab
Top Out
Water Service
Sanitary Sewer
R.'. o rains
PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
O
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA / 72$ /"21 Approach /Sidewalk Date .5W Inspector i ce Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.