Permit r a CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2011 -00027
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/10/2011
TIGARD Parcel: 25101 DB00614
Jurisdiction: Tigard
Site address: 13275 SW 76TH AVE
Project: Frezza Subdivision: ROLLING HILLS Lot: 19
Project Description: Connect existing house to sewer service. Reimbursement District Fee #44 fee paid this date.
Contractor: Owner: FREZZA, CONRAD NICHOLAS & APRIL
13275 SW 76TH AVE
TIGARD, OR 97223
PHONE: PHONE: 503 - 620 -5629
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/10/2011 $4,100.00
Sewer Inspection - Residential 02/10/2011 $35.00
Type of Use: Reimbursement District Revenue 02/10/2011 $6,000.00
Class of Work:
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $10,135.00
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. • - • .re set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUN by calling 503.2 9: • 1.8S0.332.2344. ,1
Iss - d By: ' � i / ti 4 Permittee Signature:
• . �
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.