Permit SEWER CONNECTION PERMIT
CITY OF TIGARD
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COMMUNITY DEVELOPMENT Permit #: SWR2010 00023
Ei Date Issued: 03/05/2010
)TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S 109 DD09600
Jurisdiction: Tigard
Site address: 15623 SW RAPHAEL LN
Subdivision: BELLA VISTA Lot: 26
Project: Bella Vista
Project Description: Connect new SFR to sewer.
FEES
Owner:
RIVERSIDE HOMES INC Description Date Amount
17933 NW EVERGREEN PKWY #370 Sewer Connection Fee 03/05/2010 $3,600.00
BEAVERTON, OR 97006 Sewer Inspection - Residential 03/05/2010 $35.00
PHONE: 503 - 645 -0986
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 0 NC by calling 503.246.6699 or 1.800.332.2344. /,
Issued By: .j • ' , I 1 k , Permittee Signature: £ � _'2 ?r ,, y 3 _ 5 _ to
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.