Permit t CITY OF TIGARD SEWER CONNECTION PERMIT
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i DEVELOPMENT SERVICES PERMIT #: SWR2001 -00257
.,� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/28/01
SITE ADDRESS; 13221 SW 68TH PKWY 200 PARCEL: 2S101 DA -00102
SUBDIVISION: TRIANGLE CORPORATE PARK ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME: CADENCE CAFETERIA
USA NO: FIXTURE UNITS: 13
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: EDU increase .3. Increase from 544 value count to 549 value count.
Owner: FEES
PACIFIC REAL ESTATE MGMT
6650 SW MACADAM AVE. 200 Type By Date Amount Receipt
PORTLAND„ OR 97201 PRMT CTR 9/28/01 $690.00 27200100000
Phone: 503 - 224 -1460 Total $690.00
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" Perm
./" (P9,
Issued by: IS, , , , /; , . . Permittee Signature: K
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1 ,
Accumulative Sewer Tally //
Tent Name _____________ : _ -/A This SWR# dui fLace) t -00 .57
Address: /3M -/ Stet/ llf 246 This PLM#: JUJ r - 00
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added Its 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 , f
Dishwasher - Commercial 4 / t
- Domestic .
Drinking Fountain 1 .
Eye Wash 1
Floor Drain/sink - 2 inch 2 1 "";
-3inch 5 / “)
- 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 — �j '4
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1 - ,
- Stall 2 ,
Sink - Bar/Lavatory 2
- Bradley • . 5
- Commercial 3
- Service 3 / (3) _ -f ? .
Swimming Pool Filter 1
Washer - Clothes . 6
Water Extractor 6 .
Water Closet - Toilet 6
Urinal 6
TOTALS
s7/4 - 67 i_ 5/I9
Total fixture values: . divided by 16 = 3 4 , 3 �— EDU i 3 L U / N�e-F. $� /0�0
HISTORY
PLM# c 4024 EDU# 34 SWR# icj -w/ &1 PLM# EDU# SWR#
PLM# / c q4 -66., ss EDU# �? SWR# / 555 -00, PLM# EDU# SWR#
PLM# i 5 _x/0 EDU# -,/ SWR# / 56 _ PLM# EDU# SWR#
PLM# 6 . oafs) EDU# ; / SWR# �g -o(b PLM# EDU# SWR#
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