Permit ITY OF T I ARD SEWER EOMNTCTION
PCNIT
PERMIT # • SWR95 -0338
COMMUNITY DEVELOPMENT PARFTI NT DATE ISSUED: 08 /28/95
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171
PARCEL: 1S126BA -01500
SITE ADDRESS...: 09724 SW WASHINGTON RD
SUBDIVISION • ZONING:
BLOCK • LOT °
TENANT NAME.....: THE GAP
USA NO FIXTURE UNITS•..:25
CLASS OF WORK...:TEN DWELLING UNITS..:1
TYPE OF USE •COM NO. OF BUILDINGS:
INSTALL TYPE •BUSWR IMPERV SURFACE..: :sf
1
Remarks: tenant improvement .
Owner: FEES
THE GAP Y. EXPRESS PERMITS - type amount by date recpt
1327 PRMT $ 2200.00 B 08/28/95 95- 269837
POST AVE.
TORRENCE C. 90501
Phone #: 310 -328 -6300
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 2200.00 TOTAL
Reg #.. :
REQUIRED I NSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspect ion
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.
Permittee Si nature:
•
Issued By: c„_,
Call for inspection — 639-4175
•
•
75- A6, g C3-7
Sewer Permit Worksheet 4U)
) r ��
Fixture Unit Ratings D 3 Jg
FIXTURE TIMES (x) TOTAL
UNIT # OF FIXTURE
FIXTURE VALUE FIXTURES VALUE
Baptistry/Font 4
Bath - Tub/Shower 4
- Jacuz/Whpl 4
Cuspidor/Water Asp 1
Dishwasher - Commer 4
- Domest 2
Drinking Fountain 1 / i
Floor Drain - 2 inch 2 Z
- 3 inch 5
- 4 inch 6
Garbage Disposal 3/4 HP) 16
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Oil Sep (Gas Sta) 6
Shower - Gang 1
- Stall 2
' Sink - Bar 2
- Bradley 5
- Commercial 3
- Service 3
Washer, Clothes 6
Water, Ext 6
Water Closet 6 / L
Urinal 6
25
Business 0 I / T Fixture Value g"."1- --g"."1- Address 1 V � M r ( • a. divided by 16 = Aa EDU
6 C,L 9 Round EDU to nearest whole number & multiply by $2200
I