Permit CITY OF T SEWER CONNECTION
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-!� � ;'�A DEVELOPMEN
SERVICES PERMIT #
CES PERMIT e SWR96-0408
DATE ISSUED: 10/23/96
PARCEL: 25110DB -00700
SITE ADDRESS...: 15532 SW PACIFIC HWY #3
SUBDIVISION • WILLOW BROOK /TIGARD PROMENADE ZONING: C —G
BLOCK • LOT •10
TENANT NAME •SUPERCUTS
USA NO - FIXTURE UNITS...: 26
CLASS OF WORK...:ALT DWELLING UNITS..: 1
TYPE OF USE °COM NO. OF BUILDINGS: 0 .
INSTALL TYPE -LTP IMPERV SURFACE: 0 sf
Remarks: Tenant improvement
Owner: FEES
DANIEL MACDONALD AIA type amount by date recpt
1040 B ST PRMT $ 2200.00 DRA 10/23/96 96- 285550
STE 214
SAN RAFAEL CA 94901
Phone #: 415 -459 -6150
Contract or:
CONTRACTOR NOT ON FILE
Phone #: $ 2200.00 TOTAL
Reg #.. .
-- REG!UIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Sewer Inspection Ay —
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 ' ase
a "Tap and Side Sewer° Permit and the Agency will inst. 1. 'ral.
Permittee igna.ure: /%l ` ice!, .
Issued B.: kinge
Call for inspection — 639 -4175
A v 1 - 1
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Commercial Building Permit Applica
pity t
o f Tigard
13125 SW Hail Blvd.
Tigard, OR 97223
(503) 639 -4171
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Jobsite A ddress : '� S � �L.L� (�- � � - t'fL , J,�' .. ... .:...:.:.... :.. .......
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Suite #
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Tenant: ,A S
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Valuation: � # -'
Owner:
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Address:
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Phone:
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Contractor:
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Address:
Type of const:
Occupancy class:
Phone:
Sprinklered? Yes No
Contractor's License #
(attach copy of current Oregon license) Sq. ft. of project
Contact
Previous use:
name & phone: Story (1st, 2nd, etc.)
Proposed use:
Architect/Engineer:
Address:
Note: Plumbing & mechanical plans
must be submitted at time of
Phone: building permit applicaon.
JOB DESCRIPTION:
Applicant Signature & Phone number
Received by: Date Received:
tion Amount v
Permit # Account Description 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:
nn 'O 0i 2-20D W 1`� `T Sewer Connection (SWUSA) 2� 0 i
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TIF (TIF -R)
Mass Transit TIF (TIF -MT)
Commercial TIF (TIF -C)
Industrial TIF (TIF -1)
Institutional TiF (TIF -IS)
Office TIF (F-O)
Water Quality (WQUAL)
Water Quantity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrl Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: 7, 7,00 7/ ® \
.
Tenant Name: Su PERC. UTS Accumulative Sewer Tally This SWR #: To - (7qa
Address:_ - S ,p,,L 4 L This PLM #: 9(4- O -3
Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry/Font 4 .
Bath - Tub /Shower ' 4 '
- Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
- Domest 2
1
Drinking Fountain 1 1 - 7 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 (L .3 to
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
Garbage Disposal 16
- Dom Ito 3/4 HP)
( 1
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
1
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2 1 t I 7
- Bradley 5 .
- Commercial 3 1 3 - 2._ (r -3 q
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6 ( c.o 1 CO
Water Extractor 6
Water Closet, Toilet 6 - 7 ( - I Z / (o t_/ 6
Urinal 6
TOTALS -).. • qL
F =' - '7" ------ 7 -- a '
Total fixture values: 0 ) Z divided by 16 =rj 15 EDU
HISTORY
•
PLM# g6 -b201 EDU# ' S SWR# / Ott ) -DD PLM# EDU# SWR#
PLM# �Ip - DOS EDU# Y SWR# 96 -1), 11 PLM# EDU# SWR#
PLM#95 6(1bEDU# q SWR# � -O 7Zl PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
•NOOinaunauwlul.2
Sewer Permit Worksheet
Fixture Unit Ratings
FIXTURE TIMES (x) TOTAL
UNIT # OF FIXTURE
FIXTURE VALUE FIXTURES VALUE
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuz/Whpl 4
CuspidoriWater Asp 1
Dishwasher - Commer 4
- Domest 2
Drinking Fountain 1
Floor Drain - 2 inch 2
- 3 inch 5 1 s
- 4 inch 6
Garbage Disposal
- Dom (to 3/4 HP) 16
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Oil Sep (Gas Sta) 6
Shower - Gang 1 ,
- Stall 2
Sink - Bar 2
- Bradley 5 _
- Commercial 3
- Service 3 3 9
Washer, Clothes 6 '1 � CO
Water, Ext 6
Water Closet 6 I (q
Urinal 6
Business V F5iZw 3 • Total Fixture Value Z--CO
Address i 5532 SW 17Ac -Wit- I+i.1 - 5 iiT - &Z- divided by 16 = = Ida = EDU
Round EDU to nearest whole number &multiply by $2200
iksn
Page No. 1 CASE HISTORY FOR CASE NO.: SWR96 -0408
• DANIEL MACDONALD AIA
15532 SW PACIFIC HWY Unit: 3
09/15/97
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
SWRA007 Application received / / / / 08/23/96 RECD 09/03/96 BON
SWRA010 Plan check by / / / / 08/23/96 08/30/96 BON
SWRA070 Ready to issue / / / / 09/03/96 PASS B 09/03/96 BON
SWRA080 (F) Issue permit / / / / 10/23/96 PASS DRA 10/23/96 JD
SWRA720 Case Finaled / / / / 10/23/96 PASS DRA 10/23/96 JD
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