Permit C ITY OF TIGARD SEWER CONNECTION PERMIT
rA DEVELOPMENT SERVICES PERMIT #: SWR2001 -00284
6 � - �� 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/11/01
SITE ADDRESS; 11560 SW 67TH AVE PARCEL: 1S136DD -00200
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 004 JURISDICTION: TIG
TENANT NAME: GREEN OFFICE
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 2.6 EDUs: New office fixtures = 58 for a total of 3.6 EDUs, less credit of 1.0 EDUs.
Owner:
FEES
GREEN, JOSEPH W Type By Date Amount Receipt
PO BOX 759
PORTLAND, OR 97207 PRMT CTR 10/11/01 $5,980.00 27200100000
INSP CTR 10/11/01 $45.00 27200100000
Phone: Total $6,025.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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" Perm
Issued by: %tiI Permittee Signature: eyN //',AL /e 4 -% /D,c,/
Call (503) 639.4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
TenaiiNaifiel S ajci e E This SWR# 0 1 DD/
Address: / / S 6 D Sul 6 ? A v E . This PLM #: 2 L O/- 4/' V65
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
- 3 inch 5 /n
- 4 inch 6
- Car Wash Dm 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 6
- Bradley 5
- Commercial 3
- Service _ 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 6 3 6,
Urinal 6
TOTALS
Total fixture values: S P divided by 16 = 3. EDU 3 • — /. D C/1EG /7" =
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