Permit H, , s CITY OF TIGARD SEWER CONNECTION PERMIT
t _-
_ COMMUNITY DEVELOPMENT Permit #: SWR2011 00139
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01!12/2012
TIGARD Parcel: 2S110BA10500
Jurisdiction: Tigard
Site address: 14222 SW 119TH PL
Project: Treehill Partition, Lot 2 Subdivision: 2010 -004 PARTITION PLAT Lot: 2
Project Description: Sewer connection for new SF.
Contractor: Owner: JT ROTH CONSTRUCTION INC
FOUR D CONSTRUCTION CO INC
12600 SW 72ND AVE #200
TIGARD, OR 97223
PHONE: PHONE: 503 - 639 -2639
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/12/2012 $4,500.00
Sewer Inspection - Residential 01/12/2012 $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 suspe for 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 callin 503.232. 987 1 00.332.2344.
Issued Permittee Signature: 9 1�/ V _ to/
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. I
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.