Permit � . q CITY OF TIGARD SEWER CONNECTION PERMIT
a - COMMUNITY DEVELOPMENT Permit #: SWR2012 -00190
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/23/2012
Parcel: 1 S135CA11200
Jurisdiction: TIGARD
Site address: 11455 SW 96TH AVE
Project: Everett Terrace, Lot 11 Subdivision: EVERETT TERRACE Lot: 11
Project Description: Sewer connection for new SF
Contractor: Owner: SAGE BUILT HOMES LLC
16280 NW BETHANY CT
BEAVERTON, OR 97006
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PHONE: PHONE: 503 - 502 -6623
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 10/23/2012 $4,665.00
Sewer Inspection - Residential 10/23/2012 $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 $4,700.00
Required Items and Reports (Conditions)
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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 - copy of rule or direct questions
to OUNC by calling 503 A 232.1987 or 1.800.332.2344.
Issued By: .bitikfte/ 414X Permittee Signature: / i `� / I ra / i
Call 503.639.4175 by 7:00 a.m. for the next available insp= do date.
This permit card shall be kept in a conspicuous place on the job site u ' it • mpletion of the oject.
Approved plans are required on the job site at the time •• .: ch Inspection.