Permit CITY OF TIGARD SEWER CONNECTION PERMIT
11111 _
U. Permit#: SWR2014-00004
COMMUNITY DEVELOPMENT
13125 SW Hall Blvd..Tigard OR 97223 503.718.2439 Date Issued: 01/22/2014
TIGARD Parcel: 2S 109AB00600
Jurisdiction: TIGARD
Site address: 14031 SW ALPINE CREST WAY
Project: Otis Subdivision: ELK HORN RIDGE ESTATES Lot: G
Project Description: Connect existing house to sewer service. Septic tank to be decommissioned.
Contractor: Owner: OTIS. BRIAN D& LORRAINE M
14031 SW ALPINE CREST WAY
TIGARD, OR 97224
PHONE PHONE: 503-504-2185
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/22/2014 $4.800 00
Sewer Inspection-Residential 01/22/2014 $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 $4,835 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 Th Tules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtai ••• of the rules or estions
to OUNC calling 503.232.1987 801.332.2344. z-1"._
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Issue By: ��! r% / L I Permittee Signature: �/ f
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.