Permit (12) CITY OF TIGARD SEWER CONNECTION PERMIT
as'' COMMUNITY DEVELOPMENT Permit#: SWR2016 00269
T(GA.R.T) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/31/2016
Parcel: 2S110BA12800
Jurisdiction: Tigard
Site address: 14075 SW 118TH CT
Project: Medallion Meadows,Lot 21 Subdivision: MEDALLION MEADOWS Lot: 21
Project Description: Sewer connection for new SF
Contractor: Owner: JT ROTH CONSTRUCTION INC
FOUR D CONSTRUCTION CO
12600 SW 72ND AVE#200
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 08/31/2016 $5,300.00
Sewer Inspection-Residential 08/31/2016 $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 $5,335.00
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.
Issued By: Jr Permittee Signature: ,derr =�
C- 13.639.4175 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 .f e project.
Approved plans are required on the job site at the time of each inspection.