Permit IR CITY OF TIGARD SEWER CONNECTION PERMIT
11 1 t :: CO MMUNITY DEVELOPMENT Permit #: SWR2011 -00127
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/21/2011
Parcel: 2S110CB08500
Jurisdiction: Tigard
Site address: 12499 SW ST ANDREWS LN
Project: Mountain View Estates, Lot 10 Subdivision: MOUNTAIN VIEW ESTATES Lot: 10
Project Description: Sewer connection for new SF.
Contractor: Owner: JT ROTH CONSTRUCTION INC
12600 SW 72ND AVE
TIGARD, OR 97223
PHONE PHONE: 503 - 639 -2639
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/21/2011 $4,500.00
Sewer Inspection - Residential 09/21/2011 $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 $4,535.00
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 sus or more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center ose rules 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 y calling 503.23 198 • 1 :00.332.2344 _
Issued / �/ I Permittee Signature: —1iiIPS.
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 p • •ct.
Approved plans are required on the job site at the time of each inspection.