Permit 1 , 1 a CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2010 -00169
T IG A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2011
Parcel: 2S102DCO5400
Jurisdiction: Tigard
Site address: 13836 SW HALCYON TER
Project: GERTZ HOMES AT EDGEWOOD LOT 4 Subdivision: GERTZ HOMES AT EDGEWOOD Lot: 4
Project Description: New SF.
Contractor: Owner: GERTZ CONSTRUCTION CO INC
19200 SW 46TH AVE
TUALATIN, OR 97062
PHONE: PHONE: 503 -692 -3390
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/14/2011 $4,100.00
Sewer Inspection - Residential 01/14/2011 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 10
Total $4,135.00
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 -0090. You may obtain . •py of the rui or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.23
Issued By: er ee Signature:
Call 503.63 . :00 a.m. for the next available inspe 'on date.
This permit card shall be kept in a conspicuous place on the job site until completion of the proj .t.
Approved plans are required on the job site at the time of each inspection.