Permit _ CITY OF TIGARD SEWER CONNECTION PERMIT
1/ ; COMMUNITY DEVELOPMENT Permit #: SWR2009 -00053
Date Issued: 06/26/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 6394171 Parcel: 2S102DC01500
Jurisdiction: Tigard
Site address: 9070 SW EDGEWOOD ST
Subdivision: Lot: 0
Project: Gertz
Project Description: Connect to sewer
Owner: FEES
GERTZ CONSTRUCTION CO INC Description Date Amount
19200 SW 46TH AVE Sewer Connection Fee 06/26/2009 $3,100 00
TUALATIN, OR 97062 Sewer Inspection - Residential 06/26/2009 $35 00
PHONE:
Contractor:
OWNER
PHONE
FAX'
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $3,135 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 -0100 You may obtai a copy of th ules
or direct questions to OUNC by calling 503.246.6699 or 1 800.332 2344
Issued By: ` ( �' k Permittee Signature: 4.-__k_. . 1
i 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.