Permit CITY OF TIGARD SEWER CONNECTION PERMIT
1111 g: COMMUNITY DEVELOPMENT Permit #: SWR2010 -00003
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/03/2010
Parcel: 2S112CC21000
Jurisdiction: Tigard
Site address: 8129 SW LANGTREE ST
Subdivision: GAGE FOREST Lot: 17
Project: Gage Forest
Project Description: Sewer connection for new SF
FEES
Owner:
J T ROTH CONSTRUCTION INC Description Date Amount
12600 SW 72ND AVE Sewer Connection Fee 02/03/2010 $3,600.00
TIGARD, OR 97223 Sewer Inspection - Residential 02/03/2010 $35.00
PHONE: 503 - 639 -2639
Contractor:
J T ROTH CONSTRUCTION
12600 SW 72ND AVE #200
TIGARD, OR 97223
PHONE: 503 - 639 -2639
FAX: 503- 624 -0239
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, or if , • . • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility i ication Center. , •se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di ct questions to OUNC by ..- ng 0 .6699 or 1.800.332.2344.
I ued By: � �y ,./ Permittee Signature: -4111111110
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 th- project.
Approved plans are required on the job site at the time of each inspection.