Permit •
CITY OF TIGARD SEWER CONNECTION PERMIT
` I COMMUNITY DEVELOPMENT Permit #: SWR2012 -00135
IGA.RD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
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Parcel: 2S 102 DC06200
Jurisdiction: Tigard
Site address: 13887 SW 90TH AVE
Project: Gertz Homes at Edgewood No. 2, Lot 11 Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 11
Project Description: Sewer connection for new SF. 5/30/13, reprinted to correct parcel information from 2S102DC01400 to
2S102DC06200.
Contractor: Owner: GERTZ CONSTRUCTION CO INC
19200 SW 46TH AVE
TUALATIN, OR 97062
PHONE: PHONE: 503 - 692 - 3390
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 10/25/2012 $4,500.00
Sewer Inspection - Residential 10/25/2012 $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 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 ma irr copy of the rules or direct questions
to OUNC by rng 50 . - 2.1 • = or 1.800.332.2344.
Issued By: I ` / j Permittee Signa e:
Call 503.639.4175 by 7:00 a.m. for the next available inspection da =
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.
CITY OF TIGARD SEWER CONNECTION PERMIT
- COMMUNITY DEVELOPMENT Permit #: SWR2012 -00135
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012
Parcel: 2S 102DC01400
Jurisdiction: TIGARD
Site address: 13887 SW 90TH AVE
Project: Gertz Homes at Edgewood No. 2, Lot 11 Subdivision: EDGEWOOD Lot: 18
Project Description: Sewer connection for new SF
Contractor: Owner: GERTZ CONSTRUCTION CO INC
19200 SW 46TH AVE
TUALATIN, OR 97062
PHONE: PHONE: 503 - 692 -3390
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 10/25/2012 $4,500.00
Sewer Inspection - Residential 10/25/2012 $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 suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification
Center. Those r 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 ng 503.232.1987 or 1.800.332.2344.
Issued B : Permittee Signature: /
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. -
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