Permit CITY OF TIGARD SEWER CONNECTION PERMIT
• r'` COMMUNITY DEVELOPMENT Permit #: SWR2011 -00065
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Date Issued: 06/08/2011
Parcel: 2S110CB08000
Jurisdiction: Tigard
Site address: 12433 SW AUTUMNVIEW ST
Project: Mountain View Estates, Lot 5 Subdivision: MOUNTAIN VIEW ESTATES Lot: 5
Project Description: Sewer connection for new SF
Contractor: Owner: JT ROTH CONSTRUCTION INC
12600 SW 72ND
TIGARD, OR 97223
PHONE: PHONE: 503 - 639 -2639
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 06/08/2011 $4,100.00
Sewer Inspection - Residential 06/08/2011 $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 th • *AR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUNC by calling 503.23 !!7 or 1.800.332.2344 4 111111111kk
Issued By: �. �/ Permittee Signature:
Call 503x63• 7:00 a.m. for the next available inspection date.
This permit card shall .e kept in a conspicuous place on the job site until completion of the pr.'-ct.
Approved plans are required on the job site at the time of each inspection.