Permit •
1
CITY TIGARD SEWER CONNECTION PERMIT
bl DEVELOPMENT SERVICES PERMIT #: SWR2001 -00330
E�� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/13/02
SITE ADDRESS; 08770 SW SCOFFINS ST PARCEL: 2S102AA -02800
SUBDIVISION: TIGARD HIGHWAY TRACTS ZONING: CBD
BLOCK: LOT:. 026 JURISDICTION: TIG
TENANT NAME: TUALATIN VALLEY MENTAL HEALTH
USA NO: FIXTURE UNITS: 46
CLASS OF WORK: ADD DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: 2.9 EDU increase. Previous fixture count was 96 for both 8750 & 8770 SW Scoffins. 8750 SW
Scoffins was demolished for a credit of 1 EDU. 62 fixture units were added for a net increase of 46
fixture units or 2.9 EDU's.
Owner:
FEES
TUALATIN VALLEY MENTAL HEALTH Type By Date Amount Receipt
8770 SW SCOFFINS RD
TIGARD, OR 97223 PRMT CTR 2/13/02 $6,670.00 27200200000
Phone: 503 - 617 -3827 Total $6,670.00
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" Perm
Issued by A, vL C AFL, L P ermittee signature;) oJo £
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
`s , r Accumulative Sewer Tally
1Z
Tenant Name AL ,J V,stT,ttp fl J» L. I EA e-7I This SWR# / "00330
Address: ' 72' 5' �CoFF This PLM #: oleo/ - 004' S
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
• - JacuzziNVhirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
•Cuspidor/Water Aspirator 1 .
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 2
Eye Wash 1 ,
Floor Drain /sink - 2 inch 2
- 3 inch 5 .
- 4 inch • 6
- Car Wash Dm 6 .
Garbage Disposal 16
- Domestic (to 3/4 HP) A ,
- 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 / P.
- Bradley 5 .
• - Commercial 3
- Service 3 y / -
S w i m m i n g Pool Filter 1
Washer - Clothes 6 ,
•
Water Extractor 6
Water Closet - Toilet 6 Co 3 4
Urinal 6
TOTALS
9(g / CAA /14Z
• // 0 N 0 L4't-eAA-et-A-A_ ee'
Total fixture values: ( divided by 16 = a • • g8 EDU — 8 • / 6 �°` ' � �i 70
a @ o,
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#
i :�ds y.doc mo w@
/R AO/ `7- .; aEba:' 87 70 e iL.K_.0
/ 875 0 . 8750 5 �.o �au.o � 4, t
ICJ /a-/oNdo/ T.