Permit CITY OF TIGARD SEWER CONNECTION PERMIT
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'= COMMUNITY DEVELOPMENT
Permit #: SWR2004 -00361
T1 +GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/24/2005
. Parcel: 2S112BA11300
Jurisdiction: TIG
Site address: 7917 SW PICKLEWEED LN
Project: BONITA TOWNHOMES Subdivision: Lot:
Project Description: New SFA sewer connection. 12/9/10, Reprint to correct street name spelling.
Contractor: Owner: JLS CUSTOM HOMES
16280 NW BETHANY
BEAVERTON, OR 97006
PHONE: PHONE: 503 - 533 -4006
FAX:
FEES
Description Date Amount
Specifics: [SWUSA] Swr Connection Fee 03/24/2005 $2,500.00
[SWINSP] Sewer Inspection Fee 03/24/2005 $35.00
Type of Use: SFA
Class of Work: NEW
Install Type: LTPSWR
Fixture Units:
Number of Dwelling Units: 1.0
Total $2,535.00
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. ose rules : e set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions
to OUN ,' by calling 503.23 • : or :00.332.2344. ��
Issu =d By: � 4 1 ; PermitteeSignat ,N, 4�y ,
Cali 503.639.4175 by 7:00 a.m. for the next available ins. - date.
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.
•
A CITY OF T I GA R D SEWER CONNECTION PERMIT
1 fk DEVELOPMENT SERVICES PERMIT #: SWR2004 -00361
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639417 DATE ISSUED: 3/24/2005
PARCEL: 2S112BA -11300
SITE ADDRESS; 07917 SW PICKELWEED LN ZONING: R
SUBDIVISION: BONITA TOWNHOMES LOT: 049 JURISDICTION: TIG
Project Description: New SFA sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFA NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
JLS CUSTOM HOMES
16280 NW BETHANY Description Date Amount
BEAVERTON, OR 97006 [SWUSA] Swr Connection Fee 3/24/2005 $2,500.00
[SWINSP] Sewer Inspection Fee 3/24/2005 $35.00
Phone: 503 - 533 - 4006 Total $2,535.00
Contractor:
REQUIRED ITEMS AND REPORTS
Phone:
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.
Issued Permittee Signature� —60
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.