Permit (188) CITY TIGARD SEWER CONNECTION PERMIT
r DEVELOPMENT SERVICES
PERMIT #: SWR1999 -00162
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/17/99
SITE ADDRESS; 16200 SW PACIFIC HY Z PARCEL: 2S1156A -00100
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SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: ALBERTSONS
USA NO: FIXTURE UNITS: 115
CLASS OF WORK: ADD DWELLING UNITS: 7
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
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Remarks: Sewer permit for plumbing work on expansion /remodel.
Owner:
FEES
IBJ SCHODER BANK & TRUST Type By Date Amount Receipt •
BY ALBERTSONS INC #565
ATTN: CORP ACCT DEPT • PRMT DST 8/17/99 $16,100.00 99- 317714
BOISE, ID 83726 Total $16,100.00
Phone:
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Contractor: .
KEEFER PLUMBING INCORPORATED
52300 SW SOUTH RD •
GASTON, OR 97119
Phone: 503 - 640 -7451
Reg #: LIC 065481
PLM 34 -94pb
Required Inspections
Sewer Inspection
ORIGINAL
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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 copies oft ese r -s or direct questions to OUNC by calling (503) 246 -1987. •
• Issued b 1,1______‘„6„„,„„,./„4. Permittee Signature:
Call (5s. 639 -4175 by 7:00 P.M. for an inspection needed the next business ss y
Tenant Name: P l-F6f_ TAO 1S 5 Accumulative Sewer Tally This SWR #: 6 - ce /424p., Address: 16 � ` 0 I 4u)9 m- Z This PLM #: PIA-I l4 9 9 — ex;',R , 7
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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 j (
Drinking Fountain 1 r r '
Eye Wash 1 • '� `� j�•
� Roor Drain /sink - 2 inch 2 n q NM 2 IM311
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP) /
- Comm (to 5 HP)
32 ✓ I 7 ,Z .
- 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 1
Sink - Bar/Lavatory 2.
- Bradley 5 M. - Commercial 3 - - - iall Z _ LI
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6
MIEN
Water Extractor 6
Water Closet, Toilet 6 P I 2 ( L
Urinal 6
TOTALS -_ 34 IN
Total fixture values: qv, ) divided by 16 = - 256.(09 EDU 2 - - ! f (J r S = 1 E J S C
HISTORY
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PLM# 9t- 00103 EDU# 6 9, SWR# 9g -o 74 PLM# EDU# SWR#
PLM# 9g-oery I EDU# a/ SWR# 9 g -per � PLM# EDU# SWR#
PLM # 374' EDU# oO SWR# 9 7 - 03 5 — 8 PLM# EDU# SWR#
PLM# 7f EDU# o?P■ SWR# 97-cp05 PLM# EDU# SWR#
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04/17/2000 Activities for Case #: SWR1999 -00162
9:16:23 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRC003 Application received 07/23/1999 DHL RECD No Hold DST 08/03/1999
SWRC008 Permit Created 08/03/1999 DEB DONE No Hold DST 08/03/1999
SWRCO25 USA Sewer Card Processed 08/03/1999 DST No Hold DST 08/03/1999
SWRC705 Sewer Inspection 08/10/1999 TLP FAIL No Hold AKJ 08/10/1999 no work being done
SWRCO32 DST Post- Review Completed 08/17/1999 BON DONE No Hold BON 08/17/1999
SWRC070 Ready to issue 08/17/1999 BON DONE No Hold BON 08/17/1999
SWRC080 (F) Issue permit 08/17/1999 GEO PASS No Hold DST 08/17/1999
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SWRC720 Case Finaled 08/19/1999 DEB DONE No Hold DEB 08/19/1999
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