Permit CITY TIGARD SEWER CONNECTION PERMIT
`mow r; DEVELOPMENT SERVICES PERMIT #: SWR1999 -00175
° " 9 - 13125 SW Hal Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/10/1999
SITE ADDRESS; 10751 SW 130TH AVE PARCEL: 1S133AC -KNOW
SUBDIVISION: KNOWLEDGE BEGINNINGS DAYCARE C ZONING: R -25
BLOCK: LOT: 001 JURISDICTION: TIG
TENANT NAME: KNOWLEDGE BEGINNINGS
USA NO: FIXTURE UNITS: 257
CLASS OF WORK: NEW DWELLING UNITS: 16
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for a new basic commercial building.
Owner:
FEES
HULSEY DEVELOPMENT CO Type By Date Amount Receipt
PO BOX 8600
BEND, OR 97708 PRMT BON 11/10/199E $36,800.00 99- 319700
INSP BON 11/10/199E $45.00 99- 319700
Phone: 541 - 385 -9285 Total $36,845.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
ORIGINAL
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 pies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: Permittee Signature: ,�'/!�
Call (503) 639 -4175 by 7:00 P.M. for an inspection neededxt business day
V
Accumulative Sewer Tally
Tena*,t Name: iV ot,J /AMY/der This SWR# /9% — OD 195
Address: /0 7 6 S W / 3U r This PLM #: — 0 O R66
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
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2 1 /
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 Ye
- 3 inch 5 / / 5
- 4 inch 6
- Car Wash Drn 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
- Staii 2
Sink - Bar /Lavatory 2 ✓ o2D
- Bradley 5
Commercial 3 , , / /
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6 '' / (p.
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS 7q 9,5 (95
Total fixture values: .oq S -) divided by 16 = G.• 044 EDU _ ! L )
HISTORY \ `1(
PLM# EDU# SWR# I PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
is \.dsts\swrtaly.doc
I
04/28/2000 Activities for Case #: SWR1999 -00175
8:47:21 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
SWRC003 Application received 08/05/1999 GEO RECD No Hold GEO 08/17/1999
SWRC008 Permit Created 08/17/1999 GEO DONE No Hold GEO 08/17/1999
SWRC705 Sewer Inspection 11/05/1999 MRS PASS No Hold AKJ 04/04/2000
SWRCO30 Hold for 09/14/1999 DEB DONE No Hold DEB 09/15/1999 Hold for conditions of approval
on CUP1999- 00002.
SWRA025 USA Sewer Card Processed No Hold DEB 09/15/1999
SWRCO31 Hold Release 11/10/1999 DEB DONE No Hold DEB 11/10/1999 Okay to issue by both PLN &
ENG.
SWRC070 Ready to issue 11/10/1999 DEB DONE No Hold DEB 11/10/1999
SWRC080 (F) Issue permit 11/10/1999 BON DONE No Hold BON 11/10/1999
SWRC720 Case Finaled 04/04/2000 AKJ DONE No Hold AKJ 04/04/2000
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