Permit 71 CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT PERMIT #: SWR2009 - 00007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2(25/2009
PARCEL: 2S 103 BA - 00122
SITE ADDRESS: 12160 SW 116TH AVE ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS NO. 2 LOT: 036 JURISDICTION: TIG
PROJECT: WRISLEY
Project Description: Connect to sewer.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner:
ALICIA WRISLEY FEES
12160 SW 116TH AVE Description Date Amount
TIGARD, OR 97223
[SWUSA] Sewer Connection Fee 2/25/2009 $3,100.00
[SWINSP] Sewer Inspection Fee 2/25/2009 $35.00
Phone: 503- 804 -8256
Total $3,135.00
Contractor:
CRESCENT PLUMBING
114 SE 45TH
PORTLAND, OR 97215
REQUIRED ITEMS AND REPORTS
Contact #: PRI 503- 233 -0738
Reg #: LIC 39784
PLM 26 -299PB
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the
date issued. The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer
laterals. If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given.
If not so located, the installer shall purchase a "Tap and Side Sewer" Permit and the Agency will install a lateral. ATTENTION: Oregon
law requires you to follow 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 copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued by gAv f) Permittee Signature: ,
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.