Permit --A, - CITY OF TIGARD SEWER CONNECTION PERMIT
• DEVELOPMENT SERVICES PERMIT #: SWR2000 -00115
Al' '� 13125 SW Hall Blvd., Tigar OR 97223 (503) 639 -4171 DATE ISSUED: 6/13/00
SITE ADDRESS; 12123 SW 69TH AVE PARCEL: 2S101AA- 02900A
SUBDIVISION: TIGARD CORPORATE CENTER ZONING: MUE
BLOCK: LOT: 00A JURISDICTION: TIG
TENANT NAME: RENAISSANCE HOLDINGS
USA NO: FIXTURE UNITS: 44
CLASS OF WORK: ALT DWELLING UNITS: 2
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Tenant improvements: adding 48 fixture units to a previous balance of 106 for a new balance of
154, capping 4 fixture units. This increases the EDU count from 7 to 9, for an increase of 2 EDU's.
Owner: FEES
SPECHT PROPERTIES Type By Date Amount Receipt
15400 SW MILLIKAN WAY
BEAVERTON, OR 97006 PRMT DEB 6/13/00 $4,600.00 0002897
Total $4,600.00
Phone:
Contractor:
Phone:
Reg #:
Required Inspections
O
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 ma ain •• • ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue y: / Permittee Signature: Z /�, �i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant blame: WA /OR/WA i vW % This SWR# R- -- CO /F
Address: l 07 la 3 .5A) - b 1r" This PLM #:x000 — Co //5
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
- JacuzziNVhirlpool 4
Car Wash - Each Stall 6
- Drive Through _ 16 .
CuspidorNVater Aspirator 1 _ .
Dishwasher - Commercial 4
- Domestic 2 .
Drinking Fountain 1 ,
Eye Wash 1
Floor Drain/sink - 2 inch 2 d2 Li .
- 3 inch 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 .
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16 .
Shower - Gang (Per Head) 1 .
- Stall 2
' S Bar/Lavatory 2
- Bradley 5 ' _
- Commercial 3 �°
- Service 3 .
Swimming Pool Filter 1 4
Washer - Clothes 6 .
Water Extractor 6 .
Water Closet - Toilet 6 `S 30
Urinal 6 ° 1.
/o6 L 1 ` i 5
TOTALS Q
L`
Total fixture values: l 9 , 3C EDU /
divided by 16 = r, 6.,--
J
c•/
HISTORY ° �
PLM# /ggq - c o cK EDU# ,z SWR #,q 9 -6o /? / PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# • EDU# SWR# PLM# EDU# SWR#
odststswrtaly.doc
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