Permit CITY TIGARD SEWER CONNECTION PERMIT
. �l DEVELOPMENT SERVICES PERMIT #: SWR2002 -00013
`�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/23/02
SITE ADDRESS; 08260 SW HUNZIKER ST PARCEL: 2S101BC -02100
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: JOHN ANNAND
USA NO: 2671 FIXTURE UNITS: 0
CLASS OF WORK: NEW DWELLING UNITS: 0
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 1.9 EDU: New connection to sewer. Existing fixture value of 32; cap 12 fixtures; add 10 fixtures;
for a new fixture value of 30, or 1.9 EDU. Septic tank to be pumped, filled and inspected, or
removed per Washington County Health Dept.
Owner:
FEES
ANNAND, JOHN D II + EDNA N Type By Date Amount Receipt
8260 SW HUNZIKER RD
TIGARD, OR 97223 INSP CTR 1/23/02 $45.00 27200200000
PRMT CTR 1/23/02 $4,370.00 27200200000
Phone: Total $4,415.00
Contractor:
Phone:
Reg #:
Required Inspections
Sewer Inspection
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" Perm
Issued b / Permittee Signature 5`a 7 )7
Call (503) 63 175 by 7:00 P.M. for an inspection needed — next business day
Accumulative Sewer Tally
Tenant tame: John Annand, Architect This SWRA 2002-000t3
Site Address: 8260 SW Hunziker Street This PLM# 2002 - 00018
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
£X /SfinJC count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 1 4 1 4 0 0 0
- Jacuzzi/Whirlpool • 4 0 0 0 0 , 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 1 2 0 0 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 1 2 1 2 0 0 0
Sink - Bar /Lavatory 2 3 6 0 2 4 5 10
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 _ 0 0 0 0 0
Washer - Clothes 6 1 6 .1 6 0 0 0
Water Extractor 6 0 0 0 0 0.
Water Closet - Toilet 6 2 12 0 1 6 3 18
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 9 32 3 12 3 10 9 30
Current Fixture Value 30 divided by 16 = 1.9 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 32 divided by 16 = 2.0 Previous EDU
Change -2 divided by 16 = -0.1 over (under) $ 4,370.00
Enter EDU Change Here 1.9
HISTORY
Notes: PLM# EDU# SWR#
PLM# EDU# . SWR#
PLM# EDU# SWR#
Name: ,,e, , Date: �c�� � )
erffomed is Fe uired
Sig ture of person hat calculated this tally sheet and date p 4
CITY cF TIGARD 24 -Hour M
BUILDING Inspection Line: (503) 639 -4175
MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ' AM PM BUP
Location g 2-66 Suite � ^-0 d e'
Contact Person Ph ( ) 62R — 68 PLM
Contractor Ph ( ) swn c 2- — 000/3
/3
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
esS
Ftg Drain ELR
Crawl Drain
Slab Inspe tion Notes: SIT
Post & Beam
Shear Anchors g 6 d
Ext Sheath/Shear /
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall -
Fire Sprinkler
Fire Alarm A r
Susp'd Ceiling
Roof
Other: /
Final
PASS PART IL •
PLUMBING
Post & Beam
n Pr � : yam•
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
c:=41 -1,,xt -
PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL.
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE. LI Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date — 70- 6 - Inspector 2 > / +_' Q P Ext
Approach /Sidewalk P
, Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL