Permit CITY OF TIGARD SEWER CONNECTION PERMIT
i COMMUNITY DEVELOPMENT Permit#: SWR2012-00214
Date Issued: 01/22/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Parcel: 1 S125CA12200
Jurisdiction: Tigard
Site address: 9375 SW 74TH AVE
Project: KHVILIVITZKY Subdivision: 2008-001 PARTITION PLAT Lot: 3
Project Description: Sewer connection for new SF
Contractor: Owner: KHVILIVITZKY,ALEXANDER&NATALY
11750 SW TIMBERLINE DR
BEAVERTON,OR 97008
PHONE PHONE 503-866-2308
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 01/22/2013 $4,665 00
Sewer Inspection-Residential 01/22/2013 $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 - c•py of the rules or direct q
to OUNC by calling 503.23 .1987 or 1.800.332 2344
Issued By: 1--41 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.