Permit CITY OF TIGARD SEWER CONNECTION PERMIT
COMMUNITY DEVELOPMENT Permit SWR2011 -00148
1 3125 SW Hall Blvd , Tigard OR 97223 503 718 2439
Date Issued 10/25/2011
TfGARD Parcel 2S111CB01706
Jurisdiction Tigard
Site address 10305 SW HOODVIEW DR
Project CIROTSKI Subdivision HOOD VIEW Lot 5, PLUS
Project Description 100 ft of sanitary sewer Reimbursement district fees paid 10/25/11
Contractor Owner CIROTSKI, LAWRENCE L AND LAURA L
10305 SW HOODVIEW DR
TIGARD, OR 97224
PHONE PHONE
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 10/25/2011 $4,500 00
Sewer Inspection - Residential 10/25/2011 $35 00
Type of Use SF Reimbursement District Revenue 10/25/2011 $6,000 00
Class of Work ALT
Install Type Building Sewer
Fixture Units
Number of Dwelling Units 1
Total $10,535 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 ; copy of the rules ri direct questions
to OUNC by calling 503 232 1987 or 1 800 332 2344 _
Issued By - -rmittee Signature
NIW
Call 50 : - 4 by 7 00 a m for the next available inspection . • -
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