Permit CITY OF TIGARD E�1� ® SEWER CONNECTION PERMIT
111 11 COMMUNITY DEVELOPMENT �'�/s�i Permit #: SWR2011 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011
Parcel: 2S110CB09800
Jurisdiction: Tigard
Site address: 15227 SW ARLINGTON TER
Project: Arlington Heights No. 3, Lot 86 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 86
Project Description: Sewer connection for new SF. 6/15/11, reprinted to correct owner information.
Contractor: Owner: SKYLINE HOMES & DESIGN
6021 SE MILWAUKIE AVE
PORTLAND, OR 97202
PHONE: PHONE: 503 - 235 - 3810
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/06/2011 $4,100.00
Sewer Inspection - Residential 05/06/2011 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
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 a copy of the rules or direct questions
to OUNC by callin � .1987 o .:00.42.2344.
�
Issued By: .4 Permittee Signature: 41
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
y e a e
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.
CITY OF TIGARD SEWER CONNECTION PERMIT
111 ' COMMUNITY DEVELOPMENT Permit #: SWR2011 -00064
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011
Parcel: 2S1100609800
Jurisdiction: Tigard
Site address: 15227 SW ARLINGTON TER
Project: Arlington Heights No. 3, Lot 86 Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 86
Project Description: Sewer connection for new SF
Contractor: Owner: COLUMBIA STATE BANK
BY JECK, AL
17800 SE MILL PLAIN BLVD, STE 10
VANCOUVER, WA 98683
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 05/06/2011 $4,100.00
Sewer Inspection - Residential 05/06/2011 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
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 adopte• - • - Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtaif a op e rules or direct questions
to OUNC by call 32.198 1.800.332.2344.
Issued By: Permittee Signature: K
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.