Permit CITY OF TIGARD SEWER CONNECTION PERMIT
' COMMUNITY DEVELOPMENT Permit #: SWR2012 -00167
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/24/2012
Parcel: 25111 CB01738
Jurisdiction: Tigard
Site address: 10400 SW HOODVIEW DR
Project: Chwirka Subdivision: HOOD VIEW NO.2 Lot: 37
Project Description: Connect existing house to sewer service.
Contractor: Owner: CHWIRKA, STEVEN A
10400 SW HOODVIEW DR
TIGARD, OR 97224
PHONE: PHONE: 503 - 620 -7777
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 07/24/2012 $4,665.00
Sewer Inspection - Residential 07/24/2012 $35.00
Type of Use: SF Reimbursement District Fee 07/24/2012 $6,000:00
Class of Work: ALT
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $10,700.00
• 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 - 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 - -fling 503.2 : 1987 •r 1.800.332.2344. Y
Issued =y: / 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 project.
Approved plans are required on the job site at the time of each Inspection.
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