Permit CITY OF TIGARD SEWER CONNECTION PERMIT
• COMMUNITY DEVELOPMENT Permit #: SWR2011 -00131
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Date Issued: 09/22/2011
Parcel: 2S110CB08400
Jurisdiction: Tigard
Site address: 12467 SW ST ANDREWS LN
Project: Mountain View Estates, Lot 9 Subdivision: MOUNTAIN VIEW ESTATES Lot: 9
Project Description: Sewer connection for new SF
Contractor: Owner: JT ROTH CONSTRUCTION INC
PO BOX 1969
LAKE OSWEGO, OR 97035
PHONE PHONE 503 - 806 -0602
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 09/22/2011 $4,500 00
Sewer Inspection - Residential 09/22/2011 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $4,535 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. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules or direct questions
to OUNC by calla . 2.1987 o _
Issued By: " Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the • eject.
Approved plans are required on the job site at the time of each inspection.