Permit (57) CITY OF TIGARD SEWER CONNECTION PERMIT
n Permit#: SWR2017-00168
• COMMUNITY DEVELOPMENT Date Issued: 02/05/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S106DB02000
Jurisdiction: Tigard
Site address: 17247 SW HOLLY RIDGE LN RIVER TERRACE NORTHWEST Lot: 20
Project: River Terrace Northwest,Lot 20 Subdivision:
Project Description: Sewer connection for new SF.
Owner: ADLV LAND HOLDINGS LLC
Contractor: BY FORSUM, MICHAEL
7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 602-694-4031
PHONE:
FAX:
FEES
Description
Date Amount
Specifics: Sewer Connection Fee 02/05/2018 $5,300.0002/05/2018 $35.00
Sewer Inspection-Residential
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
ru eSfor
are setthe
forth 180 days.
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questions
Center. Those
to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: OA/ (j-207,4=/e //C7<J
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.