Permit CITY TIGARD SEWER CONNECTION PERMIT
., DEVELOPMENT SERVICES PERMIT #: SWR2003 -00190
' 13125 SW Hall B lvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 817/03
SITE ADDRESS; 14580 SW 120TH PL PARCEL: 2S110BC -02600
SUBDIVISION: WALL PARTITION /MLP2001 - 00006 ZONING: R - 7
BLOCK: LOT: 001 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF detached residence.
Owner: FEES
MASTERPIECE CONSTRUCTION INC
14225 SW 128TH PL. Description Date Amount
TIGARD, OR 97224 [SWINSP] Swr Inspect 8/7/03 $35.00
[ SWINSP] Swr Inspect 8/7/03 $0.00
Phone: 503- 267 -6730 [SWUSA] Swr Connect 8/7/03 $2,400.00
[SWUSA] Swr Connect 8/7/03 $0.00
Contractor:
Total $2,435.00
Phone:
Reg #:
Required Inspections
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" Perm
Issued by: ,��L/p/f Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day