Permit (194) CITY OF TIGARD SEWER CONNECTION PERMIT
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COMMUNITY DEVELOPMENT Permit:: SWR2015-00195
. 4 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2016
Parcel: 1 S 136AA12100
Jurisdiction: TIGARD
Site address: 10128 SW 67TH AVE
Project: Oak Street Estates,Lot 16 Subdivision: OAK STREET ESTATES Lot: 16
Project Description: Sewer connection for new SF
Contractor: Owner: LENNAR NORTHWEST INC
11870 NE 99TH ST, STE 1170
VANCOUVER,WA 98682
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/06/2016 $5,100.00
Sewer Inspection-Residential 01/06/2016 $35.00
Type of Use: SF
Class of work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,135.00
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 Oreqgn Utility Notification
Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of t as direct questions
to OUNC by calliZ&zi—
Issued By: Permittee Signature:
Call 503.638.4176 by 7:00 a.m.for the next available InspectionUateThis permit card shall be kept in a conspicuous place on the job site until compa project.Approved plans are required on the job site at the time of each ins