Permit CITY OF TIGARD SEWER CONNECTION PERMIT
2 ; COMMUNITY DEVELOPMENT Permit #: SWR2010 -00020
Date Issued: 03/03/2010
TIUARL? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112BD09700
Jurisdiction: Tigard
Site address: 14657 SW 78TH AVE
Subdivision: BRITTANY MEADOWS Lot: 33
Project: Brittany Meadows
Project Description: Connect new SFR to sewer.
Owner: FEES
WEBBER PROPERTIES LLC Description Date Amount
12155 SW WILDWOOD ST Sewer Connection Fee 03/03/2010 $3,600.00
PORTLAND, OR 97224 Sewer Inspection - Residential 03/03/2010 $35.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $3,635.00
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: / r, i/. . Permittee Signature: 6/// lC 7-70 /
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 1
® i SEWER CONNECTION
il B , BUILDING SERVICES DIVISION
j. PERMIT
13125 SW Hall Blvd., Tigard, OR 97223
T I ;G A R D; 503 - 639 -4171 www.tigard- or.gov
c. ,,1 = ? <_ .._ PERMIT #: SW�Z?Q10, 0C-.)C320
DATE ISSUED: J 1 l 0
SITE ADDRESS: I 1.4 LQ 5 - at in Akfk PARCEL #: aa ze 7CO
BLDG /STE #: ZONING:
SUBDIVISION: _)( j_ RGt a01, ).s LOT: 73 JURISDICTION: 'C c % ,
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
PROJECT DSGRIP'TION c c ' - O r1 r _ Sc. t L ° - - - -_ .e._ , T .
TENANT NAME:
CWS NO.: FIXTURE UNITS:
CLASS OF WORK _ .ew -- _— — DWELLING UNITS:
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: -Li - k kc L g , t,J'?.._ IMPERV SURFACE:
� __ _ - .._ OWNER .
__ ___ —. _ ,, l .__. ry ... , __.._ _____ -_.___ _ ____. -FEES -_._�-
Name: — -- - — - Sewer connection $ )
Address: Sewer inspection $ c71
City/State/Zip: -- - - - — -- - - - -- - -- Total Fees: $ -2 �
Phone:
—_.� ._ ..__ -- CONTRACTOR �.. ' _----- .— .___ -,
Name: _
Address: _ __
City/State /Zip: - Lo OS.
0. _,o p� Qc 7a ,
Phone: E..„.0_3_1,2:35 -
Fax: _
CCB Lic #: l_j .�j — -- — — —
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services Agency. The permit expires 180 days from the date issued.
The total amount paid will be forfeited if the permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the'sewcr is not
located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given. If not so located, the installer shall purchase a
"Tap and Side Sewer" Permit and the Agency will install a lateral. ATI' N'l7ON: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. "Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0080. You may obtain copies of these rules or direct
questions to OUNC by calling
503 -246 -1987 or 1- 800 - 332 -2344. ( �
Issued By: .GA (�Q v 1l 1 \, a b Permittee Signature: ' - 4
Call 503 - 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718-2433 for assistance.
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. •
I: \Building \Manual Permit System \ManualSWRpermit.doc 03/14/06