Permit (15) CITY OF TIGARD SEWER CONNECTION PERMIT
1 1111a ' COMMUNITY DEVELOPMENT Permit#: SWR2023-00183
Date Issued: 7/3/2023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 25110A601800
Jurisdiction: Tigard
Site address: 14260 SW 114TH AVE
Project: ROTHROCK Subdivision: COLE'S ACRES Lot: 5
Project Description: Sewer connection for existing dwelling and(2)ancillary dwelling units.Septic tank to be pumped and filled.
Contractor: Owner: ROTHROCK, PHILIP M TRUST
2228 NE 22ND AVE
PORTLAND, OR 97212
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/29/2023 $9,937.50
Sewer Inspection-Residential 06/29/2023 $35.00
Type of Use: SFA
Class of Work: OTR
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1.5
Total $9,972.50
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 for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the/i{ rrules�
Issued By: / - Permittee Signature: Lii]ri-+
C .639.4175 by 7:00 a.m.for the next available inspection date.
This 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.