Permit 7 SEWER CONNET 7 C)ni
PERMIT
c . . .
F T I CAR �'
DATE 06/27/96 —
ATE
COMMUNITY DEVELOPMENT DEPARTMENT • • . •
13125 SW Hall Blvd. Tigard, Oregon 97223.8199. (503) 639 -4171 PARCEL: 25101 AA - 00100
SITE ADDRESS...: 12000 SW 66TH AVE.
SUBDIVISION ° WEST PORTLAND HEIGHTS ZONING: C —G,
.BLOCK........... LOT ' °'17 ..
TENANT NAME °LANDMARK FORD
USA NO FIXTURE UNITS....: 19
CLASS OF WORT'.... :ALT • :DWELLING UNITS..: 1. .
TYPE OF USE °COM NO. OF BUILDINGS: 0
INSTALL TYPE.... :BUSWR IMPERV SURFACE: 0. sf
Remarks: RE: PLM96 -0175 fixtures in premanufactured structures .
Owner: - - - -- FEES - -.
LANDMARK FORD type • amount by •date recpt
12000 SW 66TH AVE . • PRMT.$ 2200.00 B 06/27/96 96- 281120
. INSP $ 45.00 B' 06/27/96.96-281120-
TIGARD OR 97223 0
Phone #: - .
•
Contractor: -- - -- ..
CONTRACTOR 'NOT ON FILE
Phone #:
$ 2245.00 TOTAL
Reg #.. :.
REQUIRED INSPECTIONS
This. Applicant agrees to cooply with all the rules and regulations • Sewer Inspection
• 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 i y will i•tall lateral. —
lei /
Permittee ai a/�t /ure ;^ vip __ __ _ _ ____
Issued By: f lkij,L4�.4 -
Call for inspection —• 639 -4175
•
•
e, Commercial Building Permit Application
City of Tigard
13125 SW Hall Blvd. ; (- ` ( ,�,� 5
Tigard, OR 97223 ` ��
(503) 639 -4171 0i o^?
1 /SP‘ n
Jobsite Address: / G <7.7_ ! c7'6 (`
� ��. K " ' Office Use Only
Tenant: Suite # ,
Valuation:
Planck/Rec #
` Permit #
� J1r43 ir .'�'.
elk l G � L .� e
Owner: Map & TL #
Address:
Approvals Required
Planning
Phone:
Engineering:
Other>
Contractor:
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:
Architect/Engineer:
Previous use:
Address:
Note: Plumbing & mechanical plans
must be submitted at time of
building permit application.
Phone:
e(.
JOB DESCRIPTION:
Applicant Signature & Phone number
Received by:
/ t Date Received: L c ,
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:
� ( e .—p3zS
Sewer Connection (SWUSA) GF Q-er-- t✓ ��
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -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 Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Ptanck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS:
•. 7 l�iG
� K l 'p' n i - ewer Tenant Name: o('� ` c(� '4' 3 ` This PLM #: 0 . ^^ 96,- ° i
Address: (F000 �� — �"' G ,( � s
jv- . ,
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
-4inch 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 ( t
Shower - Gang (Per Head) 1 _ ,
-Stall 2 � - — 2— �
Sink - Bar /Lavatory
Bradley 5 3
- Commercial 3 I '
- Service 3
Swimming Pool Filter 1
—'her, Clothes 6
Water Extractor 6 �
Water Closet, Toilet 6 L
_ /
Urinal 6
TOTALS �; C I _
Total fixture values: "f divided by 16 = 6 L' EDU �� �- i�
I- S f
HISTORY
y GL 2'7 C7 (fl
PLM# EDU# L7 SWR # / � /e (:n «,.re 5 . , PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR# ,
:uogmimasw,ai.a