Permit CITY TIGARD SEWER CONNECTION PERMIT
mil' DEVELOPMENT SERVICES PERMIT #: SWR2000 -00348
� - I± 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/30/00
SITE ADDRESS; 06825 SW SANDBURG ST PARCEL: 2S101 DD -00400
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT: 001 JURISDICTION: TIG
TENANT NAME: TOC OFFICE ADDITION
USA NO: FIXTURE UNITS: 99
CLASS OF WORK: ADD DWELLING UNITS: 6
TYPE OF USE: COM NO. OF BUILDINGS: 1
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Sewer assessment for fixtures added to an 11,361 square foot building addition. Adding 99 fixtures
values for an increase of 6 EDU's.
Owner:
FEES
TOG MANAGEMENT SERVICES Type By Date Amount Receipt
6825 SW SANDBURG STREET
TIGARD, OR 97223 PRMT CTR 11/30/00 $18,400.00 27200000000
Total $18,400.00
Phone: 620 -1710
Contractor:
Phone:
Reg #:
Required Inspections
This Applicant agrees to comply with all the rules and regulations of the Unified Sewage Agency. The permit expires
180 days from the date issued. The total amount paid will be forfeited if the permit expires. The Agency does not
guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the installer
shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a "Tap and
Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon law requires you to follow rules adopted
by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Accumulative Sewer Tally
Tenant Narfi OC Qf'G /C e /P)b• This SWR #. Q °9 "CC 3 ' g .
Addre ss 6$a5 bw. S9►o)&12.6 This PLM #: PLt aooO - 00 ( 00
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 . , I Y
- Domestic 2
Drinking Fountain . 1
Eye Wash , 1 '
Floor Drain /sink - 2 inch 2 5 /0 .
. -3inch 5 , .
- 4 inch 6 -
- Car Wash Drn 6 -
' Garbage Disposal 16 .
- Domestic (to 3/4 HP) ,
- Commercial (to 5 HP) ' 32 '/ - '.3,2
- Industrial (over 5 HP) ' 48 " V
Ice Machine /Refrigerator Drains , 1 •
. Oil Sep (Gas Station) , 6 • . ,
Rec. Vehicle Dump Station 16 . •
Shower - Gang (Per Head) 1 V
-Stall 2 Go '
Sink - Bar /Lavatory 2 8
• - Bradley 5
- Commercial 3 / 3 l 3 ' .
- Service 3 . • .
Swimming Pool Filter . , . 1 •
Washer - Clothes 6 '
Water Extractor . . 6 .
Water Closet - Toilet = 6 /d Coo
Urinal 6 A / Z " q -
TOTALS /400 ' 3 /32 0�
95 divided by 16 /2.0"/ EDU N 1 C-Tt�s o ' , .
Total fixture values:'"
HISTORY )) C2.e_A I0 EIDLA :5
' PLM# . EDU# SWR# ' PLM# EDU# SWR# ,
PLM# EDU# . . SWR #" ' PLM# ' EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU #. SWR# PLM# . EDU# SWR# .
i:ldsts\swrtaly.doc .