Permit i
CITY TIGARD SEWER CONNECTION PERMIT
r DEVELOPMENT SERVICES PERMIT #: SWR1999 -00256
r � 11 1 1 3125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/03/1999
SITE ADDRESS; 16290 SW UPPER BOONES FERRYRD PARCEL: 2S113AB -01201
SUBDIVISION: B,b,Ntl O CREEK ACRE TRACTS ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: ALT DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: IMPERV SURFACE:
Remarks: Dummy permit to remove and replace 2 sinks, 1 lavatory and 2 water closets. No change in
EDU.
Owner:
FEES
PACTRUST
15350 SW SEQUOIA PKWY Type By Date Amount Receipt
#300
PORTLAND, OR 97224 Total
Phone:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202
Phone: 236 -4152
Reg #: LIC 172
PLM 26 -83PB
- Required Inspections
ORIGINAL
. 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 copie of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued by: j-Q it..4 6 ) Permittee Signature:
'
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
4 Accumulative Sewer Tally
Tenane - Name: F L 1 (� S `{S rb5 This SWR# Su) K 1999 — 00 2 -S 6
Address: 11x2 '70 s u-penz 1 i-«ry RD (A.47 E This PLM #: PL f `l 19- covac!?
I .
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added Its 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
- Domestic 2 o .
Drinking Fountain 1 _
Eye Wash 1
Floor Drain /sink - 2 inch 2 _ ,
- 3 inch 5
•
-4 inch 6 ,
- Car Wash Drn 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 I � 1 O
-
- Bradley 5 .
- Commercial 3 9- to -2- to O
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 2 12- L /l._. O
Urinal 6
TOTALS
Total fixture values divided by 16 = E EDU
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#
s:%dstslswrtaly.doc