Permit coNNCc'T I cN
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PERMIT
CI lY OF TIGARD DATE ISSUED: . 07/09/'96 -0260
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 2511 1 BD -02700
SITE ADDRESS...: 14650 SW 97TH AVE
SUBDIVISION....: CLOUD CAP ZONING: R -3.5
BLOCK LOT .9
TENANT NAME.....:TWALITY MIDDLE SCHOOL
USA NO..........a FIXTURE UNITS...: 16
CLASS OF WORK— :ALT DWELLING UNITS..: 1
TYPE OF USE .ED NO OF BUILDINGS: 0
INSTALL TYPE .LTPSWR IMPERV SURFACE: 0 sf
Remarks: Interior remodel
Owner: --------- -- FEES - - --
TIGARD TUALATIN SCHOOL DIST type amount by date • recpt
13137 SW PACIFIC HWY PRMT $ 22000.00 CJS 07/09/96 96- 281428
TIGARD OR 97223
Phone #: 684 -2353
Contractor:
MICHAEL WATT
PO BOX 82374
3625 SE 17TH
PORTLAND OR 97282 - - -•- _ -_ _______
Phone # 238 -0866 $ 2200.00 TOTAL
Reg #..: 64584
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 ii in r � •11 a�
,, , . __ ----------- -
Permittee Signature: / � j i 1� i vw
Issued By: 4 , / • _ •
Call for inspection - 639 -4175
•
_ -
Commercial Building Permit Application
,City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 •
(503) 639 -4171
Jobsite Address: i 4 1 -Q 1 � d I HA—
e Use.
Tenant. � �A -�A � Suite #
Valuation:
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Owner:
Address:
royals Re �
PP 4
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• Phone:
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Contractor: g
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:
Applicant Signature & Phone number
Received by: Date Received:
Permit ; Account Description Amount Amt. Pd. Bal. Due
Bldg. Permit (BUILD)
Plumb. Permit (PLUMB)
Mech. Permit (MECH)
State Tax (TAX)
Bldg:
Plumb:
Mech:
Plan Check (PLANCK)
Bldg: •
Plumb:
Mech:
Sewer Connection (SWUSA) 1700 ZZD2
Sewer Inspection (SWINSP)
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 -O)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: ZO°
•
h .
Tenant Name: 11/tal k, W\AAGO C t Accumulative Sewer Tally
This SWR # q/ " OLIO()
Address: ) yO Su.) h- This PLM #:_ "i/o - 1)115
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/Whirlpool 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 ) ' 0
- 3 inch 5
o
- 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
- Stall 2
Sink - Bar /Lavatory 2 3 (p z_ 4 S LI
• - Bradley 5
- Commercial 3 I S L IC 2 15 D ,
- Service 3 ■ 1
Swimming Pool Filter 1 ,
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 ) g - Z 12- e IZ
Urinal 6 I (' 1 D
, I b
, TOTALS l(6 y -t `{ -
•
Total fixture values: 1- 00 divided by 16 = ZC EDU
HISTORY
PLM# EDU# Zf SWR# Q ,� ,� j „ PLM# EDU# SWR#
PLM# EDU# SWR# ! PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# _ PLM# EDU# SWR#
i:\dsts\j imd\swrtaty.doc