Permit CITY OF TIGARD SEWER CONNECTION PERMIT
11111 s COMMUNITY DEVELOPMENT Permit#: SWR2014-00125
T fGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/25/2014
Parcel: 2S103AC01800
Jurisdiction: Tigard
Site address: 11200 SW FONNER ST
Project: Booth Subdivision: WALNUT GLEN Lot: D
Project Description: Lift house to add foundation and unfinished basement with laundry room and bathroom. Connect existing house to
sewer service. Public sewer connection done under PFI2014-00098. No change in footprint of structure.
Contractor: Owner: BOOTH, DAVID K
3005 N PACIFIC HWY W
RICKREALL, OR 97371
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 11/25/2014 $4,900.00
Sewer Inspection-Residential 11/25/2014 $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 $4,935.00
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 throu.h 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: Permittee Signature: 1,f) f�
NNW
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Call 50 •- 'rg5 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.