Permit CITY OF TIGARD
SEWER CONNECTION
n a l E ' '� 'lll l DEVELOPMENT LOPMEN R SERVICES ACES PERMIT #PERMIT . SWR98 -0183
DATE ISSUED: 08/12/98
PARCEL: 2S102CB -02300
SITE ADDRESS...: 13200 SW PACIFIC HWY
SUBDIVISION •FREWINGS ORCHARD TRACTS ZONING: C —G
BLOCK LOT :008 JURISDICTION: TIG
TENANT NAME •MULLIKAN MEDICAL CENTER
USA NO • FIXTURE UNITS...: 13
CLASS OF WORK...:ALT DWELLING UNITS..: 1
TYPE OF USE •COM NO. OF BUILDINGS: 0
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
Remarks: RE: PLM98 -0238
Owner: FEES
MULL IRAN MEDICAL CENTER type amount by date recpt
13200 SW PACIFIC HWY PRMT $ 2300.00 DEB 08/12/98 98- 30805
TIGARD OR 97223
Phone #:
Contractor:
OWNER
Phone #: $ 2300.00 TOTAL
Reg #...
REQUIRED INSPECTIONS
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 -010 through OAR 952 w.'.1-0080. You say obtain copies of
these rules or direct questions to OUNC by calling (503)246 -1987.
Issued •y: b • _cOiLi . 4, Permittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
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{ ( i.ia W I t k I4 l► 4- 3-iI \ Vs/!
Accumulative Sewer Tally .
' : Tenant Name: /� i' ( • K7 `r Ce V rr This SW "
R# :it- . i ?- o / g' 3
. Address: 13 e 7 e) 5i--( r r-`z" ,1—° ` This PLM #: Pc—r `7)F-- c e
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 I ,
Drinking Fountain 1 a 1 x- g--
Eye Wash 1
Floor Drain /sink - 2 inch 2 •ti
. - 3 inch 5 _ ,
- 4 inch 6
- Car Wash Dm 6 •
Garbage Disposal 16
- Domestic (to 3/4 HP)
• - Commercial (to 5 HP) 32
- Industrial (over 5 HP) a8
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 I 2- 2--- °
- Bradley 5
- Commercial 3 rnii) rill IL a (- 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 / • C0 (P V
Urinal 6
TOTALS IS , -% /4
Total fixture values: 1 H I divided by 16 = 8M 2 -- EDU
HISTORY
PLM# EDU# ; ' W'# 1 0VV z PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR# _
PLM# EDU# SWR# PLM# EDU# SWR#
iMstslswrtaly.doc
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