Permit •
R EVISED
CITY OF TIGARD
07-'/-3. l SEWER CONNECTION PERMIT
CC OMMUNITY DEVELOPMENT Permit #: SWR2013 00001
T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2013
Parcel: 2S 111 BA02300
Jurisdiction: Tigard
Site address: 14320 SW 100TH AVE
Project: McCleod Subdivision: INGEBRAND HEIGHTS Lot: 29
Project Description: 1 EDU to connect existing house to sewer 2/5/13 REPRINTED to correct specific permit information
Contractor: Owner: MCCLEOD, SEAN & AMANDA
14320 SW 100TH AVE
TIGARD, OR 97224
PHONE: PHONE: 818 - 235 -4326
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/07/2013 $4,665.00
Sewer Inspection - Residential 01/07/2013 $35.00
Type of Use: SF Reimbursement District Fee 01/07/2013 $6,000.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $10,700.00
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 may obtain a copy of the rules or direct questions
to OUNC by calling 503.23 .1 87 or 1.800.332.2344.
rj� p / �/� �-1 Issued By: &Le Permittee Signature: (/ I 4 f PLk - 1 tok
///IIIXXX I 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.
CITY OF TIGARD SEWER CONNECTION PERMIT
111 1- COMMUNITY DEVELOPMENT Permit #: SWR2013 00001
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/07/2013
Parcel: 25111 BA02300
Jurisdiction: Tigard
Site address: 14320 SW 100TH AVE
Project: McCleod Subdivision: INGEBRAND HEIGHTS Lot: 29
Project Description: 1 EDU to connect existing house to sewer
Contractor: Owner: MCCLEOD, SEAN & AMANDA
14320 SW 100TH AVE
TIGARD, OR 97224
PHONE: PHONE: 818- 235 -4326
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/07/2013 $4,665.00
Sewer Inspection - Residential 01/07/2013 $35.00
Type of Use: SF Reimbursement District Fee 01/07/2013 $6,000.00
Class of Work: ALT
Install Type:
Fixture Units:
Number of Dwelling Units:
Total $10,700.00
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 may obtain a copy of the rules or direct questions
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: /�JJP p (/ // Permittee Signature: / 1�,
j���� "lll ✓ I/�-► t Call 503.639.4175 by 7:00 a.m. for the next available inspec on da e.
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.