Permit CITY OF TIGARD SEWER CONNECTION PERMIT
s. COMMUNITY DEVELOPMENT Permit #: SWR2013 -00102
Tigard OR 97223 503.718.2439
1 3125 SW Hall Blvd., Ti Date Issued: 04/29/2013
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Parcel: 2S 109AC00500
Jurisdiction: TIGARD
Site address: 14695 SW 133RD AVE
Project: Hummel Subdivision: HIGHLAND HILLS ESTATES Lot: A
Project Description: Connect existing house to sewer service, approximately 225'. Septic tank is to be pumped and filled or removed.
Contractor: Owner: HUMMEL, B W & GERALDINE B
14695 SW 133RD
TIGARD, OR 97223
PHONE: PHONE: 503 - 639 -2873
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/29/2013 $4,665.00
Sewer Inspection - Residential 04 /29/2013 $35.00
Type of Use: SF
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4,700.00
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. The - • - 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 b calling 503. .198 rr 1.800.332.2344.
Issued = '4 /OF
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.