Permit A
CITY OF TIGARD
SEWER CONNECTION PERMIT
DEVELOPMENT SERVICES
PERMIT #: SWR2000 -00273
--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/30/00
SITE ADDRESS; 12286 SW SCHOLLS FERRY RD PARCEL: 1S1346C -00300
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME: BAJA FRESH
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS: 2
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Sewer permit for plumbing work associated with tenant improvement.
Owner: FEES
BURNHAM PACIFIC Type By Date Amount Receipt
10135 SE SYNNYSIDE RD SUITE 25
CLACKAMAS, OR 97015 PRMT CTR 8/30/00 $4,600.00 27200000000
Total $4,600.00
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 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 throug OAR 952 - 001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246- 987.
Issued by: / Permittee Signature:
Call 5 03) 639 -4175 by 7:00 P.M. for an inspection needed the next bu . iness day
� / Accumulative Sewer Tally
Tenant Name: /. Gt. This SWR# o — d a a 3
Address: RA ; , iT/ I__ \ This PLM #: ,4 e1 ?A
2 /
( .Q TN-is Ad, / 0,,Nd, is .47 /.z V.80 640 Se_ c.GS FoeY 02-t:
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
- JacuzziiWhirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4 / /
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Orain/sink - 2 inch 2 '
- 3 inch 5 3 9•S—. f '" O__--4- -4
- 4 inch 6
- Car Wash Orn 6
Garbage Disposal 16
- Domestic (to 3/4 HP) I l
- 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 3 4 7 q.
- Bradley 5
- Commercial - 3 �---. 3 3
- Service 3 / •
Swimming Pool Filter 1 _ _ .--
Washer - Clothes • 6
Water Extractor 6
Water Closet - Toilet 6 .3 10 / q ''-
Urinal 6 , '
30 g Z N 943
TOTALS //
33S divided by 16 = 2 /. `� 4 EDU = v / £b "./5
Total fixture values: 0-7 � eoft. 4� a gcc S
H ISTORY g/340 344, /A40 Az-a /9 iii.
PLM# EDU# • SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
ticiSts1swnaly.doc lvl IM 0-'f / �� (4 W ()CI ZA y1_ 4--7
1/,9/66
� s9 - A59 7 �
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested � 1 AM PM BLD
Location /22-86 5W scAol(6 Frfr7 Suite MEC
Contact Person Ph ,jai " % -393 / PLM
Contractor Ph SWR -2-Ova - co;l 73
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
■
Misc:
Final
PASS PART FAIL
• LUMBI e
Post &Beam p tele ender Slap —� d 6 e"
Top Out ■,
Water Service
Sanitary Sewer
Rain Drains
Fi
ASS PART FAIL
MEC HANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date F 3/ Inspector 7 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
L