Permit •
o CITY OF TIGARD SEWER CONNECTION PERMIT
-COMMUNITY DEVELOPMENT Permit#: SWR2012 -00203
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2012
Parcel: 2S102DC01400
Jurisdiction: TIGARD
Site address: 13762 SW 90TH AVE
Project: Gertz Homes at Edgewood No. 2, Lot 18 Subdivision: GERTZ HOMES AT EDGEWOOD NO.2 Lot: 18
Project Description: Sewer connection for new SF
Contractor: Owner: GERTZ CONSTRUCTION CO INC
19200 SW 46TH AVE
TUALATIN, OR 97062
PHONE PHONE:
FAX:
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FEES
Description Date' Amount
Specifics: Sewer Connection Fee 11/19/2012 $4,665.00
Sewer Inspection - Residential 11/19/2012 $35.00
Type of Use: SF •
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Class of Work: NEW -
Install Type: Line Tap and Building Sewer
Fixture Units: .
Number of Dwelling Units: 1
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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 a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �I �1 _ 1/ f f , Permittee Signature: old APR,/ 4,n
Call by 7:00 a.m. for the next available inspection d r r
y ate .
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.