Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2009 -00138
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/11/2010
Parcel: 2S109DD09400
Jurisdiction: Tigard
Site address: 15576 SW RAPHAEL LN
Subdivision: BELLA VISTA Lot: 24
Project: Bella Vista
Project Description: Connect new SFR to sewer.
Owner: FEES
RIVERSIDE HOMES INC Description Date Amount
1300 DEXTER AVE NORTH #500 Sewer Connection Fee 02/11/2010 $3,600.00
SEATTLE, WA 98109 Sewer Inspection - Residential 02/11/2010 $35.00
PHONE:
Contractor:
RIVERSIDE HOMES LLC
17933 NW EVERGREEN PKWY 370
BEAVERTON, OR 97006
PHONE: 503 - 645 -0986
FAX: 503 - 690 -2942
Type of Use: SF
Class of Work: NEW
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 1 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 -0100. You may obtain a copy of the rules
or direct questions toO UNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: � ` C ! ' • Permittee Signature: F Azei Z l / — l0
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.