Permit
y'p CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit#: SWR1999-00137
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/23/1999
Parcel: 2S112D000500
Jurisdiction: TIG
Site address: 15875 SW 72ND AVE
Subdivision: Lot:
Project: OREGON STATE DEPT HUM
Project Description: Dummy sewer permit. PLM1999-00192 was for moving & capping of 11 fixtures, they have a
credit of 1 DU.
FEES
Owner:
PACIFIC REALTY Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224
PHONE:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202
PHONE:
FAX:
Type of Use: COM
Class of Work: ALT
Install Type: BUSWR
Fixture Units: -24
Number of Dwelling Units: -1.0
Total $0:00
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for moire the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY TIGARD SEWER CONNECTION PERMIT
PERMIT #: SWR1999 -00137
s tjl DEVELOPMENT Tigard, ) 639 -4171 DATE ISSUED: 6/23/99
- 13125 SITE ADDRESS; 15875 SW 72ND AVE PARCEL: 2S112DC -00500
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 040 . JURISDICTION: TIG
TENANT NAME: OREGON STATE DEPT OF HUMAN RES
USA NO: FIXTURE UNITS: -24
CLASS OF WORK: ALT DWELLING UNITS: -1
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Dummy sewer permit. PLM1999 -00192 was for moving & capping of 11 fixtures, they have a credit
of 1 DU.
Owner: FEES
PACIFIC REALTY
15350 SW SEQUOIA PKWY #300 Type By Date Amount Receipt
PORTLAND, OR 97224
Total
Phone:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202
Phone: 236 -4152
Reg #: LIC 172
PLM 26 -83PB
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 obtain c 'es of these rules or direct questions to OUNC by calling (503) 246 -1987.
J O A
Is ued by: , . ! , :� � �� Permittee Signature:
- Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Tenant . Namja Pr. 6 F 14H4-iJ IGi 5, 0u R- s Accumulative Sewer Tally This SWR #: 144 q - 3 7
Address: /5275 5w 72 AOC- This PLM #: Iq 4 q - oc , 14 -
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 J (�
Dishwasher - Commer 4 ' `I 1
- Domest 2
Drinking Fountain - 1
Eye Wash .1 n, �}
Floor Drain /sink - 2 inch 2 1 O� 4 `
• - 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 3 (p
- Bradley 5
- Commercial 3 (. WIEN1111 3
- Service 3
Swimming Pool Filter 1
Washer. Clothes 6 -__
, Water Extractor 6 Q
Water Closet, Toilet 6
Urinal 6
TOTALS A510 et 3 aJ S c t c9 3 °`
Total fixture values: g3 divided by 16 = 1 Lis so EDU = IS - - CALkik & i '�- .
HISTORY
_PLM# EDU# ` t
6 SWR# / jattr2L., PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#