Permit . _
CITY OF TIGARD
.a DEVELOPMENT SERVICES
13125 SEWER CONNECTION
PERMIT
PERMIT # • SWR97 -0205
DATE ISSUED: 07/04/97
PARCEL: 26112DA- 01300
SITE ADDRESS...:O664O SW REDWOOD LN #301
SUBDIVISION •MLP96 -0002 ZONING: I —P
BLOCK LOT • JURISDICTION: TIG
TENANT NAME •ORTHOPEDIC & FRACTURE CLINIC
USA NO FIXTURE UNITS...: 37
CLASS OF WORK...:ALT DWELLING UNITS..: 2
TYPE OF USE •COM NO. OF BUILDINGS: 0
INSTALL TYPE •BUSWR IMPERV SURFACE: 0 sf
Remarks: Re: PLM97 -0223
Owner: FEES
SISTERS OF PROVIDENCE type amount by date recpt
9205 SW BARNES PRMT $ 4400.00 DRA 06/27/97 97- 296491
PORTLAND OR 97225
Phone #:
Contract or:
OWNER
Phone #: $ 4400.00 TOTAL
Reg #.. .
REQUIRED INSPECTIONS
This Applicant agrees to comply with all the rules and regulations Case Finaled
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- through OAR 952 -0001 -0080. You may obtain copies of
these rules or direct questions to OUNC by calling (503)24 -1987.
Issued by: Permittee Signature:
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
r [ '1-`4-? mulative Sewer Tally
Tenant Name: Or1 - ' ` `r "'� This SWR# 9.3- -0 ZQ S
Address:�(c , io � dZ r er(--- <....� `50) This PI C 9 7 -c "Fz
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
Drinking Fountain 1 a _ 'E
Eye Wash 1
Floor Drain /sink - 2 inch 2 S 1( �, / 6.
3 inch 5 1 `j / S
- 4 inch 6
- Car Wash Dm 6 _
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- 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 /Cn j 2
- Bradley • 5
- Commercial 3 c '$ Zit 3 6 l o g
- Service 3 ? - 3 c j
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 '6 ciS ( Co 9 5
Urinal 6
•
TOTALS - / - F/ F
Total fixture values: (��` divided by 16 = l EDU _ I , Cc -ems E .
S _
HISTORY
PLM# q _ 0011 EDU# I I SWR# '37 -01 PLM# EDU# SWR#
PLM# EDU# lotriki SWR# PLM# EDU# . SWR#
PLM# EDU# . SWR# PLM# EDU# SWR# -
PLM# EDU# SWR# PLM# EDU# SWR#
i:ldstslswrtaly.doc