Permit V OF TIGARD SEWER CONNECTION PERMIT
i • COMMUNITY DEVELOPMENT Permit #: SWR2010 00060
Date Issued: 06/11/2010
STf f1Rp 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S109DA18000
Jurisdiction: TIGARD
Site address: 15243 SW SUMMERVIEW DR
Subdivision: ARLINGTON HEIGHTS NO. 3 Lot: 109
Project: Arlington Heights
Project Description: Sewer connection for new SF
FEES
Owner:
STONE BRIDGE HOMES NW, LLC Description Date Amount
16869 SW 65TH AVE., #505 Sewer Connection Fee 06/11/2010 $3,600.00
LAKE OSWEGO, OR 97035 Sewer Inspection - Residential 06/11/2010 $35.00
PHONE: 503 - 387 -7577
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, o • ork for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N ification Center. Those rul e set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dire t questions to OUNC by ing 5 .6699 or 1.800.332.2344.
lss ed By: U �Q � Perm ittee Signature: (L L / r/
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.