Permit •r CITY OF TIGARD SEWER CONNECTION PERMIT
°E7 ° COMMUNITY DEVELOPMENT Permit # SWR2011 -00150
Date Issued 10/25/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Parcel 2S103DC00807
Jurisdiction Tigard
Site address 13610 SW 115TH AVE
Project Rivera Subdivision VIRGINIA ACRES Lot 5
Project Description Connect existing house to sewer service
Contractor Owner RIVERA, EUSEBIO E & SHIRETTA
13610 SW 115TH AVE
TIGARD, OR 97223
PHONE PHONE 503- 684 -1615
FAX
FEES
Description Date Amount
Specifics. Sewer Connection Fee 10/25/2011 $4,500 00
Sewer Inspection - Residential 10/25/2011 $35 00
Type of Use SF Reimbursement District Revenue 10/25/2011 $6,000 00
Class of Work ALT
Install Type Line Tap and Building Sewer
Fixture Units
Number of Dwelling Units 1
Total $10,535 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 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 c• . r - 2 7 .r 1 800 332 2344 /
Issued B '• e2-111,<A,1 Permittee Signature / i i 14 —
est, 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