Permit •i CITY OF TIGARD SEWER CONNECTION PERMIT
r� DEVELOPMENT SERVICES PERMIT #: SWR2001 -00212
! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/1/01
SITE ADDRESS; 12909 SW 68TH PKWY 400 PARCEL: 2S101AD -03200
SUBDIVISION: TIGARD OFFICE BUILDING ZONING: MUE
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: NORTHWEST EVALUTION
USA NO: FIXTURE UNITS: 42
CLASS OF WORK: ADD DWELLING UNITS: 2
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 2.8 EDU increase. Previous fixture units were 259, this permit adds 42 fixture units for a new total
of 301, or 18.8 EDU's.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 PRMT CTR 7/31/01 $200.00 27200100000
PRMT CTR 8/1/01 $6,240.00 27200100000
Phone: Total $6,440.00
Contractor:
Phone:
Reg #:
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 may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: Permittee SignatureK 7 i /°
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th • next business day
Accumulative Sewer Tally
Tenant Name: AL/W I/iF - s T ✓ V., A i i o This SWR# 001 OD a21.-
Address: /2909 to 8` P k � Y 3e1 >t 4 ' ' o 4 This PLM #: cioo I - 00 302
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 oZ 7 °Z
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 a y A - /
- 3 inch 5
-4inch 6 -
- Car Wash Drn 6
Garbage Disposal 16 / / / /�
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48 , -
Ice Machine /Refrigerator Drains 1 c °Z
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16 / ,
Shower - Gang (Per Head) 1
- Stall 2 � , --
Sink - Bar /Lavatory 2 / a- / 2 ..
- Bradley 5 /
/_ _
- Commercial 3 °2 C.P °2 c4)
- Service 3 ,
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6 _
Water Closet - Toilet 6 / / • 4
Urinal 6 .
TOTALS a.5-9 • X 30 i
Total fixture values: 301 divided by 16 = /8.8.1. EDU /_ ` 0' € " A-41 L --j
C S 0 --6 00
HISTORY
PLM #a000- oog3lo EDU# /C SWR # -eon (o PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
r.\dsts■swrtaly.doc