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Permit SEWER CONNECTION CITY OF TIGARD PERMIT PERMIT # • SWR96 -0375 ' COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: © /21 /96 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 2S1 10DB -00200 SITE ADDRESS...: 15199 SW ROYALTY PKWY SUBDIVISION • WILLOWBROOK FARM /ARBOR HEIGHTS ZONING: R -25 BLOCK • LOT •8 TENANT NAME -ARBOR HEIGHTS USA NO FIXTURE UNITS...: 0 CLASS OF WORK...:NEW DWELLING UNITS..: 5 TYPE OF USE °COM NO. OF BUILDINGS: 2 INSTALL TYPE •LTPSWR IMPERV SURFACE: 4620 sf Remarks: OFFICE /REC BUILDING Owner: FEES SECURITY CAPITAL PACIFIC TRUST type amount by date recpt SUITE 201 PRMT $ 11000.00 JMH 08/21/96 96- 283125 330 112TH AVE., NE INSP $ 45.00 JMH 08/21/96 96- 283125 BELLEVUE WA 98004 Phone #: 206- 451 -9292 Contractor: CONTRACTOR NOT ON FILE Phone #: $ 11045.00 TOTAL Reg #... REQUIRED INSPECTIONS This Applicant agrees to comply with all the rules and regulations Sewer Inspection i 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 in all ateral. Permittee Signature: _i��'C - Issued By: 961/04d;6,44 Call for inspection — 639 -4175 • c.-,0eA no/ /o�i6 T Ter 4 e rJ1ame: f4-2 /C,e H- 7 Accumulative Sewer Tally This SWR #: G`0375 Address: /5/ 99 %.51-0 fVA Y/ P, l / - T W y ^ vE-- This PLM #: NVA MSTgh -MOq( 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 . Drinking Fountain 1 Eye Wash 1 Floor Drain /sink - 2 inch 2 wS /0 - 3 inch 5 _ ,7 /57 • - 4 inch 6 ' - Car Wash Drain 6 Garbage Disposal 16 // - Dom (to 3/4 HP) / / (o - Comm (to 5 HP) 32 - Ind (over 5 HP) 48 Ice Machine /Refrigerator Drains 1 — — Oil Sep (Gas Station) 6 Recreational Vehicle Dump Station 16 Shower - Gang (Per Head) 1 - Stall 2 ) .Sink - Bar /Lavatory 2 3 ,6 - Bradley 5 - Commercial 3 / 3 Service 3 to Swimming Pool Filter 1 Washer, Clothes 6 _ Water Extractor I 6 Water Closet, Toilet 6 3 I Urinal . 6 / (p TOTALS g,-3 Fig 5 aol - , (,/ 0 Total fixture values: $5 divided by 16 = 5. 3- EDU 5 1S 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# :Uownvgnouw,ul.2 Page No. 1 CASE HISTORY FOR CASE NO.: SWR96 -0375 SECURITY CAPITAL PACIFIC TRUST 15199 SW ROYALTY PKWY 05/08/98 Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By SWRA010 Plan check by / / / / 08/02/96 08/02/96 J *H SWRA070 Ready to issue / / / / 08/06/96 APPR JMH 08/06/96 J *H SWRA080 (F) Issue permit / / / / 08/21/96 PAID JMH 08/21/96 J *H SWRA705 Sewer inspection / / / / 10/01/96 300' -10 " 30 -34 PASS MS 10/02/96 MRS 6 "sewer 300' SWRA720 Case Finaled / / / / 10/01/96 PASS MS 01/30/97 MRS • • • 7/27/99 Activities for Case #: SWR96 -00375 1:57:57 PM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By . Updated Notes SWRA010 Plan check by 8/2/96 • J'H 8/2/96 SWRA705 Sewer Inspection 10/1/96 • MS PASS MRS 10/2/96 300'- 10 "30 -34 6 "sewer 300' SWRA070 Ready to issue 8/6/96 - JMH APPR J'H 8/6/96 SWRA080 (F) Issue permit 8/21/96 JMH PAID J'H 8/21/96 SWRA720 Case Finaled 10/1/96 MS PASS MRS 1/30/97 • • • Page 1 of 1 •