Permit •
A 11 CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT
Permit #: SWR2009 -00126
T I GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/20/2009
Parcel: 2S111AB01300
Jurisdiction: Tigard
Site address: 9195 SW ELROSE CT
Subdivision: ELROSE TERRACE Lot: 8
Project: Kern
Project Description: Connect existing house to sewer service. Reimbursement District No. 36 fee paid 11/20/09.
FEES
Owner:
KERN, THOMAS G & JULIE ANN Description Date Amount
9195 SW ELROSE CT Sewer Connection Fee 11/20/2009 $3,600.00
TIGARD, OR 97224 Sewer Inspection - Residential 11/20/2009 $35.00
PHONE: 503 - 620 -8019
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $3,635.00
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 for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification - iter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direct que ons to OU 1 by c. ' g 503.246.6699 or 1.800.332.2344.
Issued =y: i O � / Permittee Signature: J� \..
,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.