Permit (154) CITY OF TIGARD SEWER CONNECTION PERMIT
.'' COMMUNITY DEVELOPMENT Permit#: SWR2018-00117
TI ARJD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/01/2019
Parcel: 2S1010001600
Jurisdiction: Tigard
Site address: 7790 SW HUNZIKER RD
Project: The Fields Apartments-Building 3 Subdivision: FIELDS APARTMENTS Lot: None
Project Description: Building 3-Sewer connection for new 1-story clubhouse. SDC fees do not apply for clubhouse used exclusively by
tenants per CWS.
Contractor: Owner: FIELDS, FRED W REVOCABLE LIVING
111 SW 5TH AVE#3675
PORTLAND, OR 97204
PHONE: PHONE:
FAX:
FEES
Description Date Amount
•
Specifics: Sewer Inspection-Commercial 07/01/2019 $45.00
Type of Use: COM
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $45.00
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: Permittee Signature: L� G
Call /9 175 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 • COMMUNITY DEVELOPMENT DEPARTMENT
1 111Request for Permit Action
TI .45x/
(..;A R D 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503-718-2439 • www.tigard-or.gov
TO: CITY OF TIGARD
Building Division
13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503-718-2439 Fax: 503-598-1960 TigardBuildingPermits@tigard-or.gov
FROM: ❑ Owner ❑ Applicant ❑ Contractor ity Staff
Check(✓)one
REFUND OR Name:
INVOICE TO: (Business or Individual) g
Mailing Address:
City/State/Zip:
Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1):
it CANCEL/VOID PERMIT APPLICATION.
❑ REFUND PERMIT FEES (attach copy of original receipt and provide explanation below).
O INVOICE FOR FEES DUE (attach case fee schedule and provide explanation below).
❑ REMOVE/REPLACE CONTRACTOR ON PERMIT (do not cancel permit).
Permit#: SOX, - 00./// 7
Site Address or Parcel#: 2 790 S Co 6471 vl/ci �'v/
Project Name: �� " 1:-7E-LA S / 7/t1 7S-
Subdivision Name: Lot#:
EXPLANATION: j�l� ,Vo r
4es- 4-Ay1 '7 ft
e-e4Js f
Signature: ,( )2 -Z _ Date: '/./rte
Print Name: /1 , 6 "'Ark!,. -
Refund Policy
1. The city's Community Development Director,Building Official or City Engineer may authorize the refund of:
• Any fee which was erroneously paid or collected.
• Not more than 80%of the application or plan review fee when an application is withdrawn or canceled before review effort
has been expended.
• Not more than 80%of the application or permit fee for issued permits prior to any inspection requests.
2. All refunds will be returned to the original payer in the form of a check via US postal service.
3. Please allow 3-4 weeks for processing refund requests.
FOR OFFICE USE ONLY
Route to Sys Admin: Date By Route to Records: Date /'7 d B'Vol" -
Refund Processed: Date /1/7 By 4:( Invoice Processed: Date By
Permit Canceled: Date,/7 f B ;��' Parcel Tag Added: Date By
I:\Building\Forms\RegPermitAction_092 4.doc