Permit CITY TIGARD SEWER CONNECTION PERMIT
.
' ' DEVELOPMENT SERVICES PERMIT #: SWR2005 -00131
° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/13/2005
PARCEL: 2S 112BC - 00100
SITE ADDRESS; 14537 SW DEKORTE TERR ZONING: R -4.5
SUBDIVISION: DURHAM ACRES LOT: 069 JURISDICTION: TIG
Project Description: New sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: BUSWR IMPERV SURFACE:
Owner: FEES
KNOWLTON, BROOK
14537 SW DEKORTE TERR Description Date Amount
TIGARD, OR 97224 [SWUSA] Swr Connection Fee 4/13/2005 $2,500.00
[SWINSP] Sewer Inspection Fee 4/13/2005 $5.00
Phone: 503- 639 -1465 Total $2,535.00
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
Reg #:
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:. Signature: t
y�.
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.
I OF '�'
CITY TIGAR.
BUILDING DIVISION PERMIT #: SWR200S -00131
13125 SW Hall Blvd., Tigard, OR 97223 D ISSUED: 4/13/2005
Phone: (503) 639 -4171 �r 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/25/2005 TIME: 7:10AM PAGE: 10
SITE ADDRESS: 14537 SW DEKORTE TERR CLASS OF WORK:
SUBDIVISION: DURHAM ACRES LOT #: 069 TYPE OF USE:
PROJECT NAME: KNOWLTON
DESCRIPTION: New sewer connection,
OWNER: KNOWLTON, BROOK, PHONE #: 503 - 639.1465
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 4/26/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 005281 -01 503- 51&4476 N
Corrections /Comments /Instructions:
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✓� El CANCEL ❑ NO ACCESS
PASS �'' PARTIAL APPROVAL
❑ FAIL • CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date: 4 , Phone #: (503) 718-