Permit •
• CITY OF TIGARD SEWER CONNECTION PERMIT
� ,, DEVELOPMENT SERVICES PERMIT #: SWR2000 -00395
I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/09/2001
SITE ADDRESS; 15350 SW SEQUOIA PKWY 100 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS: 314
CLASS OF WORK: ALT DWELLING UNITS: 2
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Remarks: Plumbing tenant improvement increased sewer usage by 1.6 EDU's. Tenant went from 295 fixture
values to 314 fixture values.
Owner: FEES
PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 PRMT CTR 01/09/2001 $3,680.00 27200100000
Total $3,680.00
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 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: DAB/ /41Y)1-/CA j
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
Accumulative Sewer Tally
Tenant Name: S This SWR# DO-39S
Address: /53.SD S41 u.44. 1 4, . P ' /DD This PLM #:.. & oo 1 /7/
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
CuspidorNVater Aspirator 1
Dishwasher - Commercial 4 ✓ I y
- Domestic 2
Drinking Fountain • 1
Eye Wash 1
Floor Drain/sink - 2 inch 2 / a
- 3 inch 5
- 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
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6 •
Water Closet - Toilet 6
Urinal 6 / �f
TOTALS 95
Q N o✓tti
Total fixture values: of t divided by 16 = / 9.4 EDU = 19 '
/. 6 'sO goo = 4 3, go-
HISTORY
PLM #ate_0 ,g EDU# /g SWR# NA PLM #qG -paa1g EDU# /g SWR #q� -
PLM# way - ao347 EDU# 1 7 SWR# (/q PLM# pop/ g EDU# j - 7 SWR# 04 0 39
.PLM# D0 , - EDU# SWR# 19'9 - 002SS PLM# p 033/ EDU# SWR# 9 a
PLM# - , , , EDU# / ; SWR# - _ 00 LAP PLM# - p p EDU# SWR# - _ O
i:ldsts■swrtaly.doc