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Permit CITY TIGARD SEWER CONNECTION PERMIT .; DEVELOPMENT SERVICES PERMIT #: SWR1999 -00269 � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/04/2000 SITE ADDRESS; 12259 SW 69TH AVE PARCEL: 2S101AA -09100 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 030 JURISDICTION: TIG TENANT NAME: RENAISSANCE HOLDINGS INC USA NO: FIXTURE UNITS: 121 CLASS OF WORK: ALT DWELLING UNITS: 1 TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: Plumbing TI with charges for sewer EDU's. Owner: FEES TIGARD CORPORATE CENTER LP Type By Date Amount Receipt 15400 SW MILLIKAN WAY BEAVERTON, OR 97006 PRMT BON 01/04/200C $2,300.00 MANUAL Total $2,300.00 Phone: Contractor: Phone: Reg #: Required Inspections OR1G?M, This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires 180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and Side Sewer' Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1 87 Issued by: '6 e ' ���' L/ Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • // Ac mutative Sewer Tally Tenant Name: AJ A /.55 'V"F_-- /p(4 4r° 5 d�� This SWR# 1 �r l - 0 Address: 1 RR 5 9 ,G J 6,4" '$ ' This PLM #: /9r9 e{Lf/ 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/Wi ,..,pool 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 • -3inch 5 -flinch 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. Vehide Dump Station 16 Shower - Gang (Per Head) 1 - Stall . 2 Sink - Bar/Lavatory • 2 • Bradley 5 _ - Commercial 3 3 - / • - Service 3 Swimming Pool Filter 1 Washer - Clothes 6 A. Water Extractor 6 Water Closet - Toilet 6 Urinal 6 , TOTALS / D6 / � I a•l Total fixture values: 1 / divided by 16 = EDU C crl€1 &) i Z7'j (ee 1= HISTORY PLM # /99q- G oaoo 2 EDU# 7 SWR #/f99 - 6a /C PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# i:ldsts\swrtaly.doc •