Permit =h.
I CITY OF TIGARD SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES PERMIT #: SWR2001 -00262
' 4 . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/20/01
SITE ADDRESS; 15865 SW 74TH AVE 110 PARCEL: 2S112DC -01400
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK ZONING: I -P
BLOCK: LOT: 004 JURISDICTION: TIG
•
TENANT NAME: BRAND INNOVATORS
USA NO: FIXTURE UNITS: 106
CLASS OF WORK: ALT DWELLING UNITS: 2
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 2.2 EDU increase. Previous fixture values were 71, this permit added 35 fixture values for a new
total of 106 fixture values.
Owner: FEES
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PACIFIC AMERICAN PROPERTY EXCH
PACIFIC SANTA FE CORP Type By Date Amount Receipt
17700 SW UPPER BOONES FERRY RD PRMT CTR 9/20/01 $5,060.00 27200100000
PORTLAND, OR 97224 Total $5,060.00
Phone:
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 " ap and Side Sewer" Perm
Per mittee Si nature:
/ � 1/ . Issued by: g lla .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the nex . sines
Tenant Name: ?QCt X-ee (c'4 Accumulative Sewer Tally This SWR #: a° °l''°15 4' L
Address:;' At '.,,," i dr i ! • f--•,e7,--'7''"'f--•,e7,--f--•,e7,--'7''"'" .t..
J
/5 d L 7 y / I D This PLM #: 7601 6o tf .19
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 / 11
- Domest 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5
- 4 inch 6 ,
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm Ito 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 7- Y ,
- Bradley 5
- Commercial 3
- Service 3 I
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6 L1
— _
Water Closet, Toilet 6 � / 6 -
Urinal 6
TOTALS '7 1 ? 3c Igl
Total fixture values: o (o divided by 16 = ( ,6 3 EDU X 60 , L v fbi,c.:} 6i-, eL�. t-- t-‘14 1 �.. 2
HISTORY o? a �` �� D�o 'o° C s/2
PLM #,2,,,p -Gb22- /EDU# y,/ / 9 PLM# EDU# SWR#
PLM #P -Z 7oEDU# / SWR# -' V c/a PLM# EDU# SWR#
PLM# 7 - voa7e,EDU# / SWR# 7 ac,--- PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
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