Permit CITY TIGARD SEWER CONNECTION PERMIT •
i , DEVELOPMENT SERVICES PERMIT #: SWR1999 -00236
" I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/09/1999
SITE ADDRESS; 11686 SW PACIFIC HWY PARCEL: 1S136CD -01700
SUBDIVISION: ZONING: C -G
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BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: MAGNOLIA HI Fl
USA NO: FIXTURE UNITS: • 32
CLASS OF WORK: NEW DWELLING UNITS: 2
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: No charge for sewer EDU's. Previously had 6 EDU's. This new building has 2 EDU's for a credit of
4EDU's. Still requires permits issuance and inspection.
Owner:
FEES
MAGNOLIA HI Fl
11680 SW PACIFIC HWY 'Type By Date Amount Receipt
TIGARD, OR 97223 INSP DST 11/09/199£ $45.00 99- 319653
Total $45.00
Phone:
Contractor:
Phone: •
Reg #:
Required Inspections
Sewer Inspection
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O RIG/NAL . •
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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 952-001-00;0.
You may obtain copies •f t se r -s or direct questions to OUNC by calling (503) 246 -19;
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Issued by: ��. Permittee Signature: , _ ,f ,
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Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the -xt business day
I p ccumulative Sewer Tally
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Tepantdvlme• Y Ill(__ l t'( 1`�`� V. This SWR# GA.* l6 7 )
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Address: (, :. -TES . I N:_ ' v l V. \J � This PLM#: l -0
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 _
CuspidorNVater Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 4 _ ) ( /
Eye Wash 1 _
Floor Drain/sink - 2 inch 2
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- 3 inch 5
p d Seber47'a'- 4 inch 6 ✓ p. I Z Z I Z
- Car Wash Dm 6 L
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48 ( , 1
Ice Machine /Refrigerator Drains 1 ^ Ll
Oil Sep (Gas Station) 6 L
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2 }—
Sink - Bar/Lavatory 2 1 ✓ L4 Z y
- Bradley 5 p
- Commercial 3 '/ 1 I 3
- Service 3 Q
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6 3
Water Closet - Toilet 6 �� 1 Z 1 Zi
Urinal . 6
pr ACLO I ( I1- 5
TOTALS tp E DO ' 5 q 1)7 6 6 /777
Total fixture values: 1 1 7 1 divided by 16 = Z- EDU N � ci
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
hdstslswrtaly.doc •
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