Permit (177) CITY OF T SEWER CONNECTION
ilor .,:r ili''� DEVELOPMENT SERVICES PERMIT
��1i � PERMIT # • SWR97 -0040
13125 SW Hall Blvd., Tigard, OR 97223 503 639.4171 DATE ISSUED: 03/07/97
PARCEL: 2S115BA -00101
SITE ADDRESS.—: 1.6200 SW PACIFIC HWY #O
SUBDIVISION--; ZONING: C - -G
BLOCK • LOT.............:
TENANT NAME •ORIGINAL CHICKEN BAR
USA NO FIXTURE UNITS...: W
CLASS OF WORK...:ALT DWELLING UNITS..: 0
TYPE OF USE •COM NO. OF BUILDINGS: 0
INSTALL TYPE •LTP IMPERV SURFACE: 0 sf
Remarks: Tenant modification
Owner: —• FEES
MCFARLANE PARTNER LP type amount by date recpt
144 MARKET ST PRMT $ 2200.00 JSD 03/07/97 97- 291426
STE 2100
SAN FRANCISCO CA 94111
Phone #:
Contractor: - - --
CONTRACTOR NOT ON FILE
Phone #: $ 2200.00 TOTAL
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 amouat 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 measuretent
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.
Permittee Signatu a �' ✓
Issued By�
Call for inspection — 639 -4175
Commercial Building Permit Application
cay of Tigara 131 :5 SW Mail Siva. flgara. OR 97:23
(503) 39 -x1
Jobsite Address: I (& Z 40.... (L )9 4O OFFICE USE ONLY ,/
/
Suite # Planck/Rec. # •
Valuation:
Permit* L�7gs* � ;:.<
Map TL # .. >;;:: . ..
Owner:
Approvals Required ,:... °:::::;:: `?. • .
Address:
Planning
E ngineering • g -r.; :: ..::., .:t7 :: \., �t�. .<Q`.�' : ,,,.Y .. : ;.v :
Telephone:
Other . . .... .. ;<_. . ::. :. . ..
Contractor.
Address:
Type of constr:
Telephone: Occupancy Class:
Contractor's License # Sprinkler? Yes No
(attach copy of current Oregon license)
Sq. Ft Of Project:
Contact name & telephone:
Story (1st, 2nd, etc.):
Architect & Engineer:
Proposed Use:
Address:
Previous use:
Note: Plumbing & mechanical plans must
Telephone: be submitted at time of building permit
application.
.08 DESCRIPTION: f__ ! Q. '4 1.-M ct7 4 Li
(Applicant Signature & Telephone Number)
teceived by: _ Date Received:
CC 11.CCC CST 'CA -o
'ERMITx Account Description Amount Amt Pd. Balance Oue -.
Building Permit (BUILD)
Plumbing Permit (PLUMB)
Mechanical Permit (MECH)
State Tax (TAX)
Bldg.
Plumb.
Mech.
Plan Check (PLANCK)
Bldg.
Plumb.
Mech. oo 00
544-97 Sewer Connection (SWUSA) A900 °WOO
Sewer Inspection (SWINSP)
Parks Dev Charge (PKSDC)
Residential TiF (T1F -R)
Mass Transit T1F (TIF -MT)
Commercial TIF (ThF -C)
Industrial TiF (T1F -I)
Institutional T1F (TIF -IS)
Office TIF (TIF-0)
Water Quality (WQUAL)
Water Quanity (WQUANT)
Fire Life Safety (FLS)
Erosion Cntrt Permit (ERPRMT)
Erosion Planck/USA (ERPLAN)
Erosion Planck/COT (EROSN)
TOTALS: ' a, oUO° oc)
I: CCMTI.CCC (CST) ) ICIS6
Tenant Name: a 1 k Ftir Accumulative Sewer Tally This SWR #: 9 7- 0/94f6
Address:l(gZ-L70 y AC1 . s ` H SUA+e. 0 , This PLM#: ''1 - <
Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
- Domest 2
Drinking Fountain 1
Eye Wash 1 np /�
Floor Drain /sink - 2 inch 2 I o. 1>
- 3 inch 5
- 4 inch 6 ,---
- Car Wash Drain 6
Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
•
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Recreational Vehicle Dump Station 16 -
Shower - Gang (Per Head) 1
- Stall 2 I
Sink - Bar /Lavatory 2 I 2. off;
- Bradley 5 //
- Commercial 3 , a 1p
- Service 3 / Y 3
Swimming Pool Filter 1
Washer, Clothes 6 4 __
Water Extractor 6
Water Closet. Toilet 6 1 LP OL l ir)
Urinal 8 t ►fir
TOTALS 334 3 v 1 33 , / ' ; .
Total fixture values: 359 divided by 16 = 2 EDU -= aGD, 351
HISTORY D6 97 aA •,tiO ..)A0-.0 Al - D,..! -
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