Permit CITY TIGARD SEWER CONNECTION PERMIT
1;� DEVELOPMENT SERVICES
PERMIT #: SWR1999 -00196
� I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/13/99
SITE ADDRESS; 15660 SW PACIFIC HWY A -6 [� GIN (. � PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM O R �J r ` ZONING: C -G
BLOCK: LOT: 011 • JURISDICTION: TIG
TENANT NAME: WU'S OPEN KITCHEN
USA NO: FIXTURE UNITS: 86
CLASS OF WORK: ALT DWELLING UNITS: 5
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Plumbing TI
Owner: FEES
TIGARD CENTER LP Type By Date Amount Receipt
9777 WILSHIRE BLVD
SUITE 609 PRMT DEB 10/13/99 $11,500.00 99- 319033
BEVERLY HILLS, CA 90212 Total $11,500.00
Phone:
Contractor:
Phone:
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 - - - :'s it and the Agency will install a lateral. ATTENTION: Oregon law requires you tb follow rules adopted
b he Oregon Utili otification Center. Those rules are set forth in OAR 952 -001 -00 I t = ig o • R 952 I a X0080.
ou may obtain copies of these r - . or dir- t questions to OUNC by calling (503 - 46),9;:7.
I ued by: I `'� ' :_ ' o g, ' i(„L j I Permittee Signature: A' /
Call (503) 639-4 75 by 7:00 P.M. for an inspection needed the ne • Hess day
__ ^,, .. _- Accumulative Sewer Tally
Tenant Name:j J l) `� ‘,2,,A6 `�!� This SWR# (Z-(' °� C01140
Address: I S e emu) &. LC y 0 This PLM# PL A i"79 - 00 Z?O
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
- JacuzziNVhiripool -4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4 ')N ✓
- Domestic 2 •
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 , ,/
- 3 inch 5 EMPA�
- 4 inch 6
- Car Wash Dm 6 •
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32 3 2.
- 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 I J o
- Bradley 5
- Commercial 3 / aj
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6 1 •
TOTALS 7.V Ail ! 1 g .2 gq
Total fixture values: 02g / divided by 16 = / g• 0� EDU N /g D `' -`' 1-4 ': " -- "L
0 5 Zcc'`:.,
HISTORY ' -- - ---- --
PLM# Flo -co p-. EDU# / SWR# 9 -toad PLM# 74 - ecc /0 EDU# fo SWR#
PLM# - oop.30 EDU# /i SWR# 0p3 p PLM# 94 - C, , 9 EDU# 5 SWR#
PLM# 9t - co333 EDU# 9 SWR# 5 -ern' 7 PLM# EDU# ,tJ SWR#
PLM# 9 !n -oco77 EDU# 7 SWR# 9 ‘ .- r /7 PLM# EDU# SWR#
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09/09/99 THU 10:52 FAX 503 598 1960 CITY OF TIGARD R003
PLEASE COMPLETE:
�T9P Fr- t, , •a-..1• ;M.°�" • p ? ° 'ES.TnY- - 1 � ' - S :CO
}r? * Y 53 }1 `; ``W_` "` " �a '1 Erg`. 3� 5. ea
441-- _. _ar. '&114 ! i ! • {11 b�L'} -
Sink 7
Lavatory 1 a. 1
Tub or Tub /Shower Combination
Shower Only
Water Closet •
Dishwasher . 2 I
Urinal 1
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Floor Sink 2" 8 2
3 "
•
4A �:
Water Heater
Other Fixtures (Specify)
crease Trap 2
Kitchen equipment 7.
COMMENTS REGARDING ABOVE:
•
•
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