Permit CITY OF TIGARD SEWER CONNECTION PERMIT
IIII _ * COMMUNITY DEVELOPMENT Permit#: SWR2021-00194
Date Issued: 7/15/2021
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 25103DA01900
Jurisdiction: Tigard
Site address: 10845 SW DERRY DELL CT
Project: Downs Subdivision: DERRY-DELL NO.2 Lot: 20
Project Description: Connect existing dwelling to public sewer.
Contractor: Owner: DOWNS, SUSAN &JASON
10845 SW DERRY DELL CT
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/15/2021 $6,085.00
Sewer Inspection-Residential 07/15/2021 $35.00
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $6,120.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended f , more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rule are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature: dv /7/c/ ( , 1)
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
T is permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.