Permit CITY OF TIGARD
SEWER CONNECTION PERMIT
' ° COMMUNITY DEVELOPMENT PERMIT #: SWR2007 - 00258
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/26/2008
PARCEL: 2S 103AD - 07500
SITE ADDRESS: 12683 SW 108TH TERR ZONING: R -4.5
SUBDIVISION: MILESBROOK LOT: 006 JURISDICTION: TIG
PROJECT: MILESBROOK
Project Description: Sewer connection for new SF.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
BUENA VISTA CUSTOM HOMES
5665 SW MEADOWS RD. #150 Description Date Amount
LAKE OSWEGO, OR 97035
[SWUSA] Sewer Connection Fee 6/26/2008 $2,800.00
[SWINSP] Sewer Inspection Fee 6/26/2008 $35.00
Phone: 503- 443 -6033
Total $2,835.00
Contractor:
Contact #: REQUIRED ITEMS AND REPORTS
Reg #:
This Applicant agrees to comply with all the rules and regulations of the Clean Water Services. 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 sewer 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. ATTENTION: 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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I 410
Issued by �� .,A.`d V: 'ermittee Signature: ��
Call 503.63 ..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.
/ ;ia 3 lag e,2_,
Building Permit Application_ FOR O FFICE USE ONLY
E . - R eceived >
City of Tigard Date/By: p ��� Permit NoMe-
c
III
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review q C
Phone: 503.639.4171 Fax: 503.598.196,0,r 0 2001 DateBy: 1 p (• I l 'ba Other P�i4v� 7 — pd A 5 d >
' ' ' ' K D . Inspection Line. 503.639 11 Date Read /By: luris: 0 See Attached Checklist for
Internet: www.tigard - or.gov CITY OF TIGARD Notif ethod: /a / Aila g . ✓ J Supplemental Information
1P�Jf I r)1NIf; f)IVi$1Q i l w _—r _ 111 '' ■
:yo- � u,° �a�r ' n as s g a � s. �
°� pKielw � R" 0 ,. , y...., TY \OF WQRK -� .� y` v`� g.. e i RE QUIRED r i i A 1` i
® New construction ❑ Demolition Permit fees* are based on the value of the work performed.
Indicate the value (rounded to the nearest dollar) of all
❑ Addition/alteration/replacement ❑ Other: equipment, materials, labor, overhead, and the profit for the
, ,,l y , ,4 . O ,� A ' CATEGORY OF
„ CONSTRUCTION ��' h y x� work indicated on this application -
. ` V ,sir , Aavi a s,,, - , ee. r ,vm a :rrr;,i f 0,7 i _ .; :: ea., r A,..:
® 1- and 2- family dwelling ❑ Commercial /industrial Valuation: $
❑ Accessory building ID Multi-family Number of bedrooms:
❑ Master builder 1:1 Other:
Number of bathrooms: 2.. S
f, k ; �, aE jJOB SITE INFORMATION ANDLOCATION {V ° .' Total number of floors: 2
'
Job site address: 11.18 SW 108 Terrace New dwelling area: 36q1 square feet
City/State /ZIP: Tigard, OR 97223 Garage /carport area: 7( 32 square feet
Suite/bldg. /apt. no.: Project name: Milesbrook Covered porch area: square feet
Cross street/directions to job site: SW 108 Terrace and SW Errol Street Deck area: NA square feet
Other structure area: square feet
REQUIRED DATA COMMERCIAL USE CHECKLIST .
Subdivision: Milesbrook I Lot no.: r Permit fees* are based on the value of the work performed.
Tax map /parcel no.: Indicate the value (rounded to the nearest dollar) of all
a and th
equipment, materials, labor, overhead, a the profit for the
g ` s kr DESCRIPTIONI OFWORK ., work indicated on this application.
NSFR Valuation: $
Existing building area: square feet
New building area: square feet
R 4l` . 0 o ®PROPERTYOWNER s§ e x #,' * r �h' ; �` Number of stories:
, {C.P a,� . N�, . „,�.,, _ ,se,. ,.. -, e _, A ,., 4., , 4 -'4n, ...�,ti
Name: Buena Vista Custom Homes Type of construction:
Address: 5665 SW Meadows Rd., Suite 150 Occupancy groups:
City/State /ZIP: Lake Oswego, OR 97035 Existing:
Phone: (503)443 -6033 Fax: (503)443 -2443 New:
f , , AP tt,, d . s CONTACT PERSON ` tin ` x , . t; i 2< t
Business name: Buena Vista Custom Homes All contractors and subcontractors are required to be
Contact name:” - licensed with the Oregon Construction Contractors Board
- - - under ORS 701 and may be required to be licensed in the
Address: 5665 SW Meadows Rd, Suite 150 jurisdiction in which work is being performed. If the
City /State /ZIP: Lake Oswego, OR 97035 applicant is exempt from licensing, the following reasons
apply:
Phone: (503) 443 -6033 Fax: : (503) 443-2443
E -mail: AustinH @BuenaVistaHomes.com
tyg zat fi ` v :, CONTRACTOR iP it a S ' 1t �: i ai
Business name: Buena Vista Custom Homes " ; BUILDING PERMIT FEE,Twr Im
trdi* '(Please,s feito.feesch
ej. " �_ ?
Address: 5665 SW Meadows Rd, Suite 150 "
City /State /ZIP: Lake Oswego, OR 97035 Structural plan review fee (or deposit):
Phone: (503) 443 -6033 Fax: (503) 443 -2443 FLS plan review fee (if applicable):
CCB lic.: 152235 Total fees due upon application:
Amount received:
Authorized signature: A This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name: Austin Holmes Date: 10/03/2007 * Fee methodology set by Tri- County Building Industry
Service Board.
1:\ Building \ Permits \BUP- PermitApp.doc 03/21/06 440- 4613T(II/02 /COM/WEB)