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: -
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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.