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Permit CITY OF TIGARD SEWER CONNECTION PERMIT 3 ' COMMUNITY DEVELOPMENT Permit #: SWR2009 00062 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/16/2009 Parcel: 2S112CC19400 Jurisdiction: Tigard Site address: 15888 SW 81ST AVE Subdivision: GAGE FOREST Lot: 1 Project: Gage Forest Project Description: Sewer connection for new SF FEES Owner: JT ROTH CONSTRUCTION INC Description Date Amount 12600 SW 72ND AVE #200 Sewer Connection Fee 07/16/2009 $3,100.00 TIGARD, OR 97223 Sewer Inspection - Residential 07/16/2009 $35.00 PHONE: Contractor: PHONE: FAX: Type of Use: SF Class of Work: NEW Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $3,135.00 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 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 to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: i \Q p la bit U �l p V Pennittee Signature: - — 'C — 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 oft e project. Approved plans are required on the job site at the time of each inspection.