Permit (140) CITY OF TIGARD SEWER CONNECTION PERMIT
tee,..
NIN ' COMMUNITY DEVELOPMENT Permit#: SWR2018-00173
n
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 .--,\,\%‘'-'' Date Issued: 07/10/2018
TIGARD g O` Parcel: 1 S135DA02400
Jurisdiction: Tigard
Site address: 11045 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Sewer connection for a new 32-bed residential care facility. 10/25/18:REPRINTED to correct address from 11035 to
11045.
Contractor: Owner: BROOKSIDE RCF LLC
5987 SE ROBHIL DR
MILWAUKIE, OR 97222
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/10/2018 $71,500.00
Type of Use: COM Sewer Inspection-Commercial 07/10/2018 $45.00
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 13
Total $71,545.00
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 1.800.332.2344.
Issued By: �X1V\.. Permittee Signature: cc ec\--.\ " -AL\.(�
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.
CITY OF TIGARD SEWER CONNECTION PERMIT
:; COMMUNITY DEVELOPMENT Permit#: SWR2018-00173
T[ D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/10/2018
[GARD
Parcel: 1S135DA02400
Jurisdiction: Tigard
Site address: 11035 SW HALL BLVD
Project: Brookside Memory Care Subdivision: METZGER ACRE TRACTS Lot: 7
Project Description: Sewer connection for a new 32-bed residential care facility.
Contractor: Owner: BROOKSIDE RCF LLC
5987 SE ROBHIL DR
MILWAUKIE, OR 97222
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/10/2018 $71,500.00
Sewer Inspection-Commercial 07/10/2018 $45.00
Type of Use: MF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 13
Total $71,545.00
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 952-00 i. 0 through O" 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: / t ittee Signature:
r�
Cal 03 6 .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.