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Permit 1 1111 q CITY OF TIGARD SEWER CONNECTION PERMIT a COMMUNITY DEVELOPMENT Permit #: SWR2012 00184 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/25/2012 Parcel: 2S114BA17800 Jurisdiction: TIGARD Site address: 9646 SW FERN HOLLOW CT Project: Fern Hollow, Lot 4 Subdivision: FERN HOLLOW Lot: 4 Project Description: New SF Contractor: Owner: RIVERSIDE HOMES LLC 17933 NW EVERGREEN PKWY, SUITE 370 BEAVERTON, OR 97006 PHONE: PHONE: 503 - 645 -0986 FAX: FEES Description Date Amount Specifics: Sewer Connection Fee 10/25/2012 $4,665.00 Sewer Inspection - Residential 10/25/2012 $35.00 Type of Use: SF Class of Work: NEW Install Type: Line Tap and Building Sewer Fixture Units: Number of Dwelling Units: 1 Total $4,700.00 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 rules 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 calli.: . . 32.1987 .r 1.800.332.2344. Issued By i • /gyp 1 4,4 1 4 Permittee Signature: ,i / 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.