Permit C ITY OF TI GARD SEWER CONNECTION PERMIT
510
A DEVELOPMENT SERVICES PERMIT #: SWR2005 -00236
I I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -417 DATE ISSUED: 005
PARCEL: 2 2S 109DD -BV003
SITE ADDRESS: 12790 SW REMBRANDT LN ZONING: R -
SUBDIVISION: BELLA VISTA LOT: 003 JURISDICTION: TIG
Project Description: New SF sewer connection.
TENANT NAME:
CWS NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1.0
TYPE OF USE: SF NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Owner: FEES
RIVERSIDE HOMES •
1925 NE AMBERGLEN PKWY.#200 Description Date Amount
BEAVERTON, OR 97006 [SWUSA] Sewer Connection Fee 11/7/2005 $2,600.00
[SWINSP] Sewer Inspection Fee 11/7/2005 $35.00
Phone: 503 645 - 0986 Total $2,635.00
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 -669• =r 1- 800 -332 -2
Issued by: t���, r.dae Permittee Signature
Call 503 -639 -4175 by 7:00 a.m. for an inspecti• • -t business day.
This permit card shall be kept in a conspicuous place on t Jo• site until completion of the project.
Approved plans ate required on the job site`•t-ihe time of each inspection.