Permit SEWER CONNECTION
CITY OF TIGARD PERMIT
PERMIT * PERMIT SWR96 -0316
DATE ISSUED: 08/08/96
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223o8199 (503) 639 -4171 PARCEL: 261 13AD -01700
SITE ADDRESS. ° ° : 16920 SW 72ND AVE
SUBDIVISION....: ROSEWOOD ACRE TRACTS ZONING: C —G
BLOCK. . ° °.°°° °° LOT— .°° °. ° ° °°°° :30
TENANT NAME :BORDERS, INC
USA NO FIXTURE UNITS. °.: 79
CLASS OF WORK. .° :ALT DWELLING UNITS.
TYPE OF USE :COM NO OF BUILDINGS: 0
INSTALL TYPE °BUSWR IMPERV SURFACE: 0 sf
Remarks: RE: PLM96 -0169
Owner: - - - - -• —• FEES - - --
BINGHAM INVESTMENTS type amount by date recpt
3939 NW ST HELENS RD PRMT $ 11000.00 JSD 08/08/96 96- 282714
INSP $ 45.00 JSD 08/08/96 96- 282714
PORTLAND OR 97210
Phone #: 224 -2676
Contractor: ---
CONTRACTOR NOT ON FILE
(=Phone #: $ 11045 .,00 TOTAL
Reg 11.
-- - - - - -- REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
of the Unified Sewage Agency. The permit expires IN 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.
A .
Permittee Signature : cTi���
-G ;1
Call for inspection — 639 -4175
Tenant Name: /,xrcers - -c Accumulative Sewer Tally This SWR#: C j %- Dato
7 p.= `/'"' This PLM #: ( 5.6 - l c) / 6 ' 5
Address: ) GFi E'0 �
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 . if `I I L(
- Domest 2
Drinking Fountain 1 Z
Z
. ,
Eye Wash 1
Floor Drain /sink - 2 inch 2 ZZ
- 3 inch 5 ' 6 -, C'_ l.P Jo
- 4 inch 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
Shower - Gang (Per Head) 1
■
- Stall 2
Sink - Bar /Lavatory 2 z O(, q Z- , L i
- Bradley 5 '
9t
- Commercial 3 ! i— L! ■ Z
- Service 3 1 I 3
o
Swimming Pool Filter 1
vAlher, Clothes 6
Water Extractor 6 /
Water Closet, Toilet 6 ``
Urinal 6 / lD I ( f
TOTALS 1
1 .
Total fixture values:
iq divided by 16 = c EDU "' E X " (' 1 ra.)ro.ECN
HISTORY
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PLM# EDU# SWR# PLM# EDU# . SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
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