Permit : q CITY OF TIGARD
SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit #: SWR2008 -00024
�K c Date Issued: 03/04/2010
T [ GARt] 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 102 DCO5100
Jurisdiction: TIG
Site address: 13778 SW HALCYON TER
Subdivision: Lot:
Project: GERTZ HOMES AT EDGEWOOD
Project Description: New SF.
FEES
Owner:
GERTZ CONSTRUCTION CO INC Description Date Amount
19200 SW 46TH AVE [SWUSA) Sewer Connection Fee 03/04/2010 $2,800.00
TUALATIN, OR 97062 [SWINSP] Sewer Inspection Fee 03/04/2010 $35.00
PHONE:
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: NEW
Install Type: LTPSWR
Fixture Units:
Number of Dwelling Units: 1.0
Total $2,835.00
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 t rules
or direct quest. • : •UNC by calling 503.246.6699 or 1.800.332.2344.
Issued :y: t // �` �� Permittee Signature: k
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.