Permit V
CITY OF TIGARD
SEWER CONNECTION PERMIT
� 4 DEVELOPMENT SERVICES PERMIT #: SWR2005 -00035
`� .. � I I 131 SW Hall Blvd., Tigard, OR 97223 5 - 6 39 -4171 DATE ISSUED: 2/7/2005
PARCEL: 2S 109DA -08500
SITE ADDRESS: 12992 SW SUMMIT RIDGE ST ZONING: ' -
SUBDIVISION: SUMMIT RIDGE LOT: 079 JURISDICTIO : URB
Project Description: Sewer connection for new SF
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
DON MORRISSETTE COMMUMITIES
4230 GALEWOOD ST # 100 Description Date Amount
PORTLAND, OR 97035 [SWUSA] Swr Connection Fee 2/7/2005 $2,500.00
[SWINSP] Sewer Inspection Fee 2/7/2005 $35.00
Phone: 503 387 - 7538 Total $2,535.00
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 -6699 or 1- 800 - 332 -2344.
Issued by: Permittee Signature:
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 the project.
Approved plans are required on the job site at the time of each inspection.
CITY TIGARD SEWER CONNECTION PERMIT
4 DEVELOPMENT SERVICES PERMIT #: SWR2005 -00035
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/7/2005
SITE ADDRESS; 12992 SW SUMMIT RIDGE ST PARCEL: 2S109DA -SR079
SUBDIVISION: SUMMIT RIDGE ZONING: R -7
BLOCK: LOT: 079 JURISDICTION: TIG
TENANT NAME:
USA NO: FIXTURE UNITS:
CLASS OF WORK: NEW DWELLING UNITS: 1
TYPE OF USE: SFM NO. OF BUILDINGS:
INSTALL TYPE: LTPSWR IMPERV SURFACE:
Remarks: Sewer connection for new SF
Owner:
FEES
DON MORRISSETTE COMMUMITIES Description Date Amount
4230 GALEWOOD ST # 100
PORTLAND, OR 97035 [SWUSA] Swr Connectic 2/7/2005 $2,500.00
[SWUSA] Swr Connectic 2/7/2005 $0.00
Phone: 503- 387 -7538 [SWINSP] Sewer Inspect 2/7/2005 $35.00
[SWINSP] Sewer Inspect 2/7/2005 $0.00
Contractor:
Total $2,535.00
Phone:
Reg #:
Required Inspections
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 -6699.
•
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Issued by "�. Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day