Permit SEWER CONNECTION
PERMIT
IT 1 oF T I GAR D
PERMIT
07/ 23/9E 6 — �
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd, Tigard, Oregon 97223o8199 (503) 639 -4171 PARCEL: 2S 1 13AB - 00800
SITE. ADDRESS...: 1€SW 74TH AVE
SUBDIVISION ° 15/C6 ZONING: I —P
.... . LOT
TENANT NAME °JADCO
USA NO FIXTURE UNITS...: 58
CLASS OF WORK...:NEW DWELLING UNITS..: 4
TYPE OF USE.....:COM NO OF BUILDINGS: 0
INSTALL TYPE °BUSWR IMPERV SURFACE: 14389 sf
Remarks: New building: JADCO RE: PLM96 -0191
Owner: FEES --
JOHN DUNCAN type amount by date recpt
16055 SW 74TH AVENUE PRMT $ 880 .00 JDA 07/23/96 96- 281953
INSP $ 45.00 JDA 07/23/96 96- 281953
TIGARD OR 97223
Phone #: 684 -0044
Contractor:
CONTRACTOR NOT ON FILE
Phone #: $ 8845.00 TOTAL
Reg #. ° :
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection
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.
Permittee Signature: \ �'
Issued By: et£ W
Call for inspection — 639 -4175
Commercial Building Permit Application
'City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223
(503) 639 -4171
Jobsite Address: "�
Tenant: ��-1-_ 6"6 Suite #
Office Use Only
Valuation:
PlaricklRec #
Permit # t ! "
Owner:
Address: Approvals Required. ..
.;:
Phone: Engineerin
9
`Other:;
Contractor: • >:.. • .:...
Address:
Type of const:
Occupancy class:
Phone:
•
Sprinklered? Yes No
Contractor's License #
(attach copy of current Oregon license) Sq. ft. of project:
Contact name & phone: Story (1st, 2nd, etc.)
Proposed use:
Architect/Engineer:
Previous use:
Address:
Note: Plumbing & mechanical plans
must be submitted at time of
building permit application.
Phone:
JOB DESCRIPTION: � ecAk
Applicant Signature & Phone number
s ‘
Received by: Date Received:`'
Permit # Account Description Amount Amt. Pd. Bal. Due =4
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX) _
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg:
Plumb:
Mech:
Sewer Connection (SWUSA)
Sewer Inspection (SWINSP) //c
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -I)
Institutional TIF (TIF -IS)
Office TIF (TIF -0)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion PlanckICOT (EROSN)
TOTALS: ��
1
Tenant, Name• - Jr CO ,d/, ,ccumuiative ewer 1 any 1 is ovvn;g:
` 417 Su,' `7 (46'" This PLM#: Pte,„ �i'G - -o 9"
• 71F'9gS _ � Su) 7 S„_,,4 94,-03e?
i
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
T
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
- Domest 2
-
Drinking Fountain 1 v
Eye Wash 1
Floor Drain /sink - 2 inch 2 ~'
- 3inch 5
- 4 inch 6
- Car Wash Drain 6 4
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
1
• Shower - Gang (Per Head) 1 _ —
- Stall 2 _
Sink - Bar /Lavatory 2 S v / 0 �i / e
- Bradley 5
Commercial 3
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6
—
Water Closet, Toilet 6 S '� 0 -- 3 G
Urinal 6 ✓ / E C / CF
1
TOTALS t I
Total fixture values: (-----) divided by 16 = -3 = `i EDU
HISTORY ________,
I v
PLM# EDU# SWR #( E W. ' PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR# -'1'
PLM# EDU# SWR# PLM# EDU# SWR#
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