Permit " CITY OF TIGARD SEWER CONNECTION PERMIT
�'1 a COMMUNITY DEVELOPMENT Permit #• SWR2012 -00172
Date Issued: 02/21/2013
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S109DA16700
Jurisdiction: Tigard
Site address: 15477 SW SUMMERVIEW DR
Project: Arlington Heights No , Lot 96 Subdivision: ARLINGTON HEIGHTS N0.3 Lot: 96
Project Description: Sewer connection for new SF
Contractor: Owner: STONE BRIDGE HOMES
4230 GALEWOOD ST, SUITE 100
LAKE OSWEGO, OR 97035
PHONE PHONE 503 - 387 -7577
FAX
FEES
Description Date Amount
Specifics: Sewer Connection Fee 02/21/2013 $4,665 00
Sewer Inspection - Residential 02/21/2013 $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 a copy of the rules or direct questions
to OUNC by ing 503 1987 0 800 332 2344
Issued 4 � � /� I � , 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.