Permit (72) CITY OF TIGARD SEWER CONNECTION PERMIT
�N COMMUNITY DEVELOPMENT Permit#: SWR2017-00222
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/28/2017
Parcel: 2S110BA13300
Jurisdiction: Tigard
Site address: 14026 SW 118TH CT
Project: Medallion Meadows,Lot 26 Subdivision: MEDALLION MEADOWS Lot: 26
Project Description: Sewer connection for new SF
Contractor: Owner: JT ROTH CONSTRUCTION INC
12600 SW 72ND AVE#200
TIGARD, OR 97223
PHONE: PHONE: 503-639-2639
FAX:
FEES
Description Date Amount
•
Specifics: Sewer Inspection-Residential 11/28/2017
$35.00
Sewer Connection Fee 11/28/2017 $5,300.00
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 yf the rules or direct quest9ns
to OUNC by calling 503.232.1987 or 1.8044.
Issued By: SL::; ;:;;;:;;;::
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rm eignature: 11°I°11:---6. /
Call 5 3.639.4175 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.