Permit CITY TIGARD SEWER CONNECTION PERMIT
A DEVELOPMENT SERVICES PERMIT #: SWR2003 -00173
c � l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/7/03
SITE ADDRESS; 10215 SW HALL BLVD PARCEL: 1S135AA -01400
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -
BLOCK: LOT: 037 JURISDICTION: TIG
TENANT NAME: INTEGUMEND LLC
USA NO: FIXTURE UNITS: 99
CLASS OF WORK: NEW DWELLING UNITS:
TYPE OF USE: COM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: 6.2 EDU's for new medical clinic.
Owner: FEES
INTEGUMEND LLC BY SCOTT COLLINS MD
& MARIA ROSS MD Description Date Amount
9495 SW LOCUST STREET [SWUSA] Swr Connect 10/7/03 $14,260.00
PORTLAND, OR 97223 [SWUSA] Swr Connect 10/7/03 $0.00
Phone: [SWINSP] Swr Inspect 10/7/03 $45.00
[SWINSP] Swr Inspect 10/7/03 $0.00
Contractor:
Total $14,305.00
Phone:
Reg #:
Required Inspections
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" Perm
Issued by: - !Lai" .`'�, 11 Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day