Permit CITY OF TIGARD SEWER CONNECTION
PERMIT
. COMMUNITY DEVELOPMENT DEPARTMENT PERMIT ##.......: SWR96- -0001
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 DATE ISSUED: 03/15/96
PARCEL: 1S134BC -00200
SITE ADDRESS...: 12160 SW SCHOLLS FERRY RD
SUBDIVISION....: ZONING C - -G
BLOCK LOT......... ....
TENANT NAME °SUBWAY
USA NO ° FIXTURE UNITS...: 15
CLASS OF WORK... :ALT DWELLING UNITS..: 1
TYPE OF USE °COM NO. OF BUILDINGS: 0
INSTALL TYPE :LTPSWR IMPERV SURFACE: 0 sf
Remarks: Tenant modification
Owner: -- -- FEES --
WILLIAM SAUNDERS type amount by date recpt
C/O MELVIN MARK PRMT $ 2200.00 JMH 03/15/96 96-277051
111 SW COLUMBIA
PORTLAND OR 97201
Phone 4:
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2200.00 TOTAL
Reg #.. .
-- - - -- R."'IRED INSPECTIONS
This Applicant agrees to cooply with all the rules and regulations Sewer I • ,pect ion
of the Unified Sewage Agency. The peroit expires 182 days froo
the date issued. The total aoount paid will be forfeited if the
peroit expires. The Agency does not guarantee the accuracy of the
side sewer laterals. If the sewer is not located at the oeasureoent
given, the installer shall prospect 3 feet in all directions froo /' / -
the distance given. If not so located, the installer shall purchase _ as -_ 4
a "Tap and Side Sewer" Peroit and the ' 3 :nstall a lateral. Tfir vir j_
Permittee Signature: _
Issued : . Issued By %I/ ��
/ Call for ins• io — 639 -4175
`7!v— —1113Z
� 11( L - °
Commercial Building Permit Application
• City bf Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
Jobsite Address: )2-1 5(A) 66(101I6 FeNYti
Tenant: VA" Suite #
Office Use Only
Planck/Rec #
Valuation:
W
T
1'1 Permit# .
Owner: ��LOR ti 5 Map & TL #
Address: C )Q -kV k V ( V
Approvals Required
1I c C D' �. Planning
Phone: V\ AZ- 11 ( Engineering
Onkjil
Other
Contractor:
Address: VOg)-- iovro6(1-
Type of const:
Occupancy class:
Phone:
nn qq ' I � Sprinklered? Yes No
Contractor's License # O n � 3 7 � I
(attach copy of current Oregon license) Sq. ft. of project:
Contact name & phone: Story (1st, 2nd, etc.)
Proposed use:
Architect/Engineer:
Previous use:
Address:
Note: Plumbing & mechanical plans
must be submitted at time of
building permit application.
Phone:
JOB DESCRIPTION:
•
Applicant Signature & Phone number
Received by: Date Received:
Permit * Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg: •
Plumb:
Mech:
•
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
t ' 00 ( _Sewer Connection (SWUSA) 7-2OO fi=t •*
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF ,(TIE =R) - •
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS) -
Office TIF • (TIF -0)
Water Quality (WQUAL')
Water '(WQ(.1ANT) ,. •
.F ire - Life Safety - •(FL -
' Erosion Cntrl Permit (ER_PRMT)
- .Erosion PlancktUSA (ERPLAN) `
Erosion Planck/COT (EROSN) - _
•
TOTALS: Zi 2 402
Tenant Name: 4 .1)6u9A - `° Accumulative Sewer Tally This SWR #: 64 — ODD(
Address: 11-1110 .,1j.) '7PrM 15 I � (( This PLM #: VP - MO 1
Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New i
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry /Font 4
Bath - Tub /Shower 4
- Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
- Domest 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 �j fQ 10
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2
- Bradley 5
- Commercial 3 3 9 9 I q
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6 .
Water Extractor 6
Water Closet, Toilet 6
1
Urinal 6
TOTALS 1- 2 ---61L., r em- eAccu: v/ L i -Dv = GA VI0 re vothIS , , -- - " l - 19
Total fixture values: I I divided by 16 = ,93 EDU ?- 5 1D6
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
dlogIn 2 -
Commercial Building Permit Application
City of Tigard
13125 SW Hall Blvd. ,t/
Tigard, OR 97223
(503) 639 -4171
Jobsite Address: I 4620 ' JU.() D Fe-r rt
fL .
Tenant: l) ( Suite # Office Use Only
/ 0t Z 0°° Planck/Rec #
Valuation: _ ,
Permit # S (�l R g ip - I
Owner: (1i \kG -uv, Ll), A,W1JJ/ /0tkdvilr, Ir C map & TL# •
Address: I l I (D L.,NJDA
Approvals Required
-- 4A/ CY l 7 zo I Planning
•
Phone: 40'6 — 13 I - (LO C
Engineering
‘1.•,1 - 114 ib
Other
Contractor: tOa 4 (DA .
Address:
Type of const:
Occupancy class:
Phone:
Sprinklered? Yes No
Contractor's License #
(attach copy of current Oregon license) Sq. ft. of project:
Contact name & phone: Story (1st, 2nd, etc.)
Proposed use:
s�
Architect/Engineer: E . R • C .
�k6 L to 'S k) 61„x 115 ti i � . Previous use:
Address:
' 1)-(46.J./41 Q�. q Z Z s Note: Plumbing & mechanical plans
must be submitted at time of
building permit application.
Phone: 2-1 Z - to 3
JOB DESCRIPTION: YeANV u) 9_ 07 °` bailk. `}(9 c- S w i 4nDk
i r► c `1
) m
one z - (�1�� 3 x I I (
Applicant Signature & one number
Received by: Date Received:
Permit # Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sui• " V6 'CM Sewer Connection (SWUSA) ?i l 2
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -1)
Institutional TIF (TIF -1S)
Office TIF (TIF -0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntri Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: WO
Tenant Name: S.) w.Aq p �� 1 umulative Sewer Tally This SWR #: '1 J - 0001
Address: OA 100 �"�fV)(4 � evU y This PLM #: 1(,) -coo I
Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry /Font 4 .
Bath - Tub /Shower 4
- Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
- Domest 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6 ,
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2
- Bradley 5
- Commercial 3 ' 3 6 i
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6
Water Closet, Toilet 6
Urinal 6
TOTAL i)0' ckwaf (p4 P0'5 (pq t IS - r
Total fixture values: --11 divided by 16 = 4.13 EDU 5 'Dv'S
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
∎.nog,oy,mm.v.,ui 2